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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


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