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of 37 available terms

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5 Written Questions

5 Matching Questions

  1. Case Rate Pricing
  2. EPO
  3. IPA
  4. MCO
  5. COBRA
  1. a Managed Care Organizations
  2. b The specialist contracts with the managed care plan for an entire episode of care.
  3. c - Independent (or Individual) Practice Association.
  4. d - Exclusive Provider Organization.
  5. e - Consolidated Omnibus Budget Reconciliation Act

5 Multiple Choice Questions

  1. - Employee Retirement Income Security Act
  2. Plan that allows members to select from three choices; HMOs, PPOs, or "Traditional" indemnity insurance.
  3. Traditional insurance; insured pays monthly premiums and 100% of medical bills until deductible is met.
  4. Physician informs the patient and telephones the referring physician that the patient is being referred for an appointment.
  5. - 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.

5 True/False Questions

  1. PreauthorizationA 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.


  2. Tertiary care- Employee Retirement Income Security Act


  3. MCO- Managed Care Organizations


  4. Self-referralThe patient refers himself or herself to a specialist, the patient may be required to inform the primary care physician.


  5. Physician Provider Group (PPG)- America's oldest privately owned prepaid medical group.


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