5 Written questions
5 Matching questions
- Case Rate Pricing
- Indemnity Plan
- Direct referral
- a - Employee Retirement Income Security Act
- b The specialist contracts with the managed care plan for an entire episode of care.
- c - Point-of-service Option or Plan
- d An authorization request form is completed and signed by the physician and handed to the patient.
- e Traditional insurance; insured pays monthly premiums and 100% of medical bills until deductible is met.
5 Multiple choice questions
- Transfer the sickest high-cost patients to other physicians so that the provider appears as a low utilizer
- Managed Care Organizations
- Is the largest pioneer in private insurance company in the United States.
- Physician informs the patient and telephones the referring physician that the patient is being referred for an appointment.
- - 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
Self-referral → Physician informs the patient and telephones the referring physician that the patient is being referred for an appointment.
Stop-Loss → - Point-of-service Option or Plan
Physician Provider Group (PPG) → Physician owned business that has the flexibility to deal with all forms of contract medicine and offers its own packages to business groups, unions and the general public.
HMO → - Quality Improvement Organization
Silent PPO Plan → - Plans purchase by existing PPOs without notifying providers who have signed contracts.
- Also known as Silent, Blind, or Phantom PPOs, Discounted Indemnity plans, Nondirected PPOs, or Wraparound PPOs.