NAME: ________________________

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5 Written Questions

5 Matching Questions

  1. Verbal Referral
  2. Churning
  3. MCO
  4. HMO
  5. Correct procedure to collect a co-payment on a MCPlan
  1. a At the time service is rendered.
  2. b Physician informs the patient and telephones the referring physician that the patient is being referred for an appointment.
  3. c - Managed Care Organizations
  4. d - Health Maintenance Organization.
  5. e 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.

5 Multiple Choice Questions

  1. Plan that allows members to select from three choices; HMOs, PPOs, or "Traditional" indemnity insurance.
  2. Is a physician who controls patient access to specialists and diagnostic testing services.
  3. - Point-of-service Option or Plan
  4. 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.
  5. Traditional insurance; insured pays monthly premiums and 100% of medical bills until deductible is met.

5 True/False Questions

  1. PPO- Exclusive Provider Organization.


  2. Self-referralAn authorization request form is completed and signed by the physician and handed to the patient.


  3. Ross-Loos Medical Group- America's oldest privately owned prepaid medical group.


  4. EPO- Exclusive Provider Organization.


  5. QIO- Quality Improvement Organization


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