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15 terms

Fordney Chapter 11 Review

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