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5 Written questions

5 Matching questions

  1. Direct referral
  2. Ross-Loos Medical Group
  3. Case Rate Pricing
  4. Churning
  5. Blue Cross/Blue Shield
  1. a The specialist contracts with the managed care plan for an entire episode of care.
  2. b Is the largest pioneer in private insurance company in the United States.
  3. c An authorization request form is completed and signed by the physician and handed to the patient.
  4. d - America's oldest privately owned prepaid medical group.
  5. e 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.

5 Multiple choice questions

  1. Card given to each enrollee of a managed care plan include and list patient's the name and member number
  2. - Health Maintenance Organization.
  3. Plan that allows members to select from three choices; HMOs, PPOs, or "Traditional" indemnity insurance.
  4. - 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.
  5. 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.

5 True/False questions

  1. MCO- Managed Care Organizations


  2. ERISA- Employee Retirement Income Security Act


  3. IPA- Preferred Provider Organization


  4. Tertiary care- Employee Retirement Income Security Act


  5. Stop-Loss- Patient services are more than absorbed amount physician can begin asking to paid.

    - Patient's services are more than certain amount, the physician can begin asking the patient to pay (fee-for-service)