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5 Written questions

5 Matching questions

  1. NCQA
  2. ERISA
  3. COBRA
  4. Withhold
  5. Blue Cross/Blue Shield
  1. a - A portion of the monthly capitation payment to physicians retained by the HMO until the end of the year to create an incentive for efficient care.

    - If the physician exceeds utilization norms, he or she will not receive it.
  2. b - Consolidated Omnibus Budget Reconciliation Act
  3. c Is the largest pioneer in private insurance company in the United States.
  4. d - National Committee for Quality Assurance, accredits HMOs.
  5. e - Employee Retirement Income Security Act

5 Multiple choice questions

  1. The specialist contracts with the managed care plan for an entire episode of care.
  2. - Health Plan Employer Data Information Set
  3. Managed Care Organizations
  4. Utilization Review
  5. - A process based on established criteria, of reviewing and controlling the medical necessity for services and providers use of medical care resources.

    - Known as Utilization or Management Control.

5 True/False questions

  1. EPO- Preferred Provider Organization


  2. Correct procedure to collect a co-payment on a MCPlanAt the time service is rendered.


  3. QIO- Quality Improvement Organization


  4. Authorization Request LogTo be used as a system for tracing referral of patients for diagnostic testing, procedures, and consultations.


  5. IPA- Exclusive Provider Organization.


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