5 Written questions
5 Matching questions
- Authorization Request Log
- Gatekeeper (Primary care physician)
- a To be used as a system for tracing referral of patients for diagnostic testing, procedures, and consultations.
- b - Independent (or Individual) Practice Association.
- c Utilization Review
- d Transfer the sickest high-cost patients to other physicians so that the provider appears as a low utilizer
- e Is a physician who controls patient access to specialists and diagnostic testing services.
5 Multiple choice questions
- At the time service is rendered.
- A requirement of some health care plans to obtain permission for a service or procedure before it is done and to see whether the insurance program agrees it is medically necessary.
- - National Committee for Quality Assurance, accredits HMOs.
- Card given to each enrollee of a managed care plan include and list patient's the name and member number
- The specialist contracts with the managed care plan for an entire episode of care.
5 True/False questions
Blue Cross/Blue Shield → The specialist contracts with the managed care plan for an entire episode of care.
HEDIS → - Employee Retirement Income Security Act
Verbal referral → 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.
Patient Information Letter → - 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).
HMO → - Quality Improvement Organization