5 Written questions
5 Matching questions
- Verbal referral
- Tertiary care
- Correct procedure to collect a co-payment on a MCPlan
- Verbal Referral
- a Physician informs the patient and telephones the referring physician that the patient is being referred for an appointment.
- b - Employee Retirement Income Security Act
- c Referral of a patient recommended by one specialist to another specialist.
- d At the time service is rendered.
- e Primary care physician informs the patient and phones the referring physician that the patient is being referred for an appointment.
5 Multiple choice questions
- The specialist contracts with the managed care plan for an entire episode of care.
- Managed Care Organizations
- The patient refers himself or herself to a specialist, the patient may be required to inform the primary care physician.
- Is a physician who controls patient access to specialists and diagnostic testing services.
- Is the largest pioneer in private insurance company in the United States.
5 True/False questions
MCO → - Quality Improvement Organization
IPA → - Exclusive Provider Organization.
Physician Provider Group (PPG) → - A process based on established criteria, of reviewing and controlling the medical necessity for services and providers use of medical care resources.
- Known as Utilization or Management Control.
QIO → Managed Care Organizations
Triple Option → Plan that allows members to select from three choices; HMOs, PPOs, or "Traditional" indemnity insurance.