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5 Written questions

5 Matching questions

  1. Authorization Request Log
  2. Churning
  3. Stop-Loss
  4. Patient Information Letter
  5. Silent PPO Plan
  1. a - Inform managed care subscriber in writing what is expected from them and what they can expect in turn.

    - Also known as Waiver of Liability in Medicare program is called Advance Beneficiary Notice (ABN).
  2. b To be used as a system for tracing referral of patients for diagnostic testing, procedures, and consultations.
  3. c When physician see a high volume of patient more than medical necessary to create revenue. May be seen in fee-service or managed care environment.
  4. d - Patient services are more than absorbed amount physician can begin asking to paid.

    - Patient's services are more than certain amount, the physician can begin asking the patient to pay (fee-for-service)
  5. e - Plans purchase by existing PPOs without notifying providers who have signed contracts.

    - Also known as Silent, Blind, or Phantom PPOs, Discounted Indemnity plans, Nondirected PPOs, or Wraparound PPOs.

5 Multiple choice questions

  1. An authorization request is required by the MCO contract to determine medical necessary, this can be done over the phone, or completed authorization form mailed, transmitted via fax or email.
  2. The patient refers himself or herself to a specialist, the patient may be required to inform the primary care physician.
  3. - Exclusive Provider Organization.
  4. Is a physician who controls patient access to specialists and diagnostic testing services.
  5. At the time service is rendered.

5 True/False questions

  1. HEDIS- Health Plan Employer Data Information Set

          

  2. ERISA- Independent (or Individual) Practice Association.

          

  3. Identification CardCard given to each enrollee of a managed care plan include and list patient's the name and member number

          

  4. Triple OptionPlan that allows members to select from three choices; HMOs, PPOs, or "Traditional" indemnity insurance.

          

  5. TurfingWhen physician see a high volume of patient more than medical necessary to create revenue. May be seen in fee-service or managed care environment.

          

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