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5 Written questions

5 Matching questions

  1. Authorization Request Log
  2. Identification Card
  3. POS
  4. Verbal Referral
  5. Silent PPO Plan
  1. a Card given to each enrollee of a managed care plan include and list patient's the name and member number
  2. b - 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. c - Point-of-service Option or Plan
  4. d Physician informs the patient and telephones the referring physician that the patient is being referred for an appointment.
  5. e To be used as a system for tracing referral of patients for diagnostic testing, procedures, and consultations.

5 Multiple choice questions

  1. The patient refers himself or herself to a specialist, the patient may be required to inform the primary care physician.
  2. - Quality Improvement Organization
  3. Plan that allows members to select from three choices; HMOs, PPOs, or "Traditional" indemnity insurance.
  4. - Health Plan Employer Data Information Set
  5. An 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.

5 True/False questions

  1. COBRA- Consolidated Omnibus Budget Reconciliation Act


  2. MCO- Exclusive Provider Organization.


  3. TurfingWhen 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. 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.


  5. ChurningTransfer the sickest high-cost patients to other physicians so that the provider appears as a low utilizer


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