An organized, interrelated system of people and facilities that communicate with one another and work together as a unit is commonly referred to as a(n):


Individuals belonging to a managed healthcare plan are referred to as:

HMOs and PPOs

The two most common types of MCOs are:

Primary care physician (PCP)

A specific provider who oversees an HMO member's total healthcare treatment is called a(n):


The amount of money a patient has to pay out-of-pocket per visit is referred to as a(n):


When an individual first enrolls in an HMO, he or she chooses a(n):

Preventive healthcare

Most managed healthcare plans emphasize:

Staff model

A multispecialty group practice where all healthcare services are provided within the building(s) owned by the HMO is called a:

Group model

An HMO that contracts with independent, multispecialty physician groups that provide all healthcare services to its members and usually share the same facility, support staff, medical records, and equipment is called a:


A reimbursement system in which healthcare providers receive a fixed fee for every patient enrolled in the plan, regardless of how many or few services the patient uses, is called a(n):

Open-panel IPA

A managed care system composed of individual healthcare providers who offer healthcare services for HMO and non-HMO patients, but maintain their own offices and identities, is called a(n):

POS plan

A plan that allows patients to use the HMO provider or go outside the plan and pay a higher copayment and deductible is a(n):


A system designed to determine the medical necessity and appropriateness of a requested medical service, procedure, or hospital admission prior, concurrent, or retrospective to the event is called:


If a particular medical service or procedure is determined not be "medically necessary," a patient may file a(n):


A procedure required by third-party payers that requires permission before a provider can carry out specific procedures and treatments is:

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