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Fordney Chapter 11 Review
A copayment in a managed care plan is usually a fixed dollar amount (predetermined fee)
In times past physicians in private practices billed indemnity insurance plans and professional services were reimbursed on a fee for services basis
Usually there are no deductibles for managed care plans
Ross-Loss medical group America's oldest privately owned prepaid medical group started in Texas
Managed care plans never require a CMS-1500 claim form to be completed and submitted
The health maintenance organization act of 1973 required most employers to offer HMO coverage to their employees as an alternative to traditional health insurance
In certain managed care plans there in an incentive for the gatekeeper to limit patient referrals to specialists
Medicare eligible patients are not involved with HMO's or prepaid health plans
If a primary care physician sends a patient to a specialist for consultation who is not in the managed care plan the specialist may bill the primary care physician for payment
In a staff model HMO physicians are hired directly by the health plan that pays their salary
The term "turfing" means to transfer the sickest high cost patient to another physician so that the provider appears as a low utilizer
Exclusive provider organization (EPO) are regulated by the federal government
Managed care plans allow laboratory test to be preformed at any facility the patient chooses
In a point of services program (POS) members may choose to use a nonprogram provider at any time
The difference between an IPA and PPG is that a PPG may not be owned by its member physician where as an IPA is physician owned