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5 Written questions

5 Matching questions

  1. HMO
  2. Blue Cross/Blue Shield
  3. Churning
  4. UR
  5. Verbal referral
  1. a Utilization Review
  2. b - Health Maintenance Organization.
  3. c When physician see a high volume of patient more than medical necessary to create revenue. May be seen in fee-service or managed care environment.
  4. d Primary care physician informs the patient and phones the referring physician that the patient is being referred for an appointment.
  5. e Is the largest pioneer in private insurance company in the United States.

5 Multiple choice questions

  1. - Exclusive Provider Organization.
  2. - Consolidated Omnibus Budget Reconciliation Act
  3. Physician informs the patient and telephones the referring physician that the patient is being referred for an appointment.
  4. An authorization request form is completed and signed by the physician and handed to the patient.
  5. At the time service is rendered.

5 True/False questions

  1. Ross-Loos Medical GroupAn authorization request is required by the MCO contract to determine medical necessary, this can be done over the phone, or completed authorization form mailed, transmitted via fax or email.


  2. Indemnity 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.


  3. Patient Information LetterCard given to each enrollee of a managed care plan include and list patient's the name and member number


  4. ERISA- Employee Retirement Income Security Act


  5. NCQA- Independent (or Individual) Practice Association.