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5 Written questions

5 Matching questions

  1. IPA
  2. HMO
  3. Preauthorization
  4. Verbal referral
  5. Identification Card
  1. a - Health Maintenance Organization.
  2. b A requirement of some health care plans to obtain permission for a service or procedure before it is done and to see whether the insurance program agrees it is medically necessary.
  3. c Primary care physician informs the patient and phones the referring physician that the patient is being referred for an appointment.
  4. d - Independent (or Individual) Practice Association.
  5. e Card given to each enrollee of a managed care plan include and list patient's the name and member number

5 Multiple choice questions

  1. - 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)
  2. - Preferred Provider Organization
  3. - 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.
  4. Referral of a patient recommended by one specialist to another specialist.
  5. - Employee Retirement Income Security Act

5 True/False questions

  1. COBRA- Independent (or Individual) Practice Association.

          

  2. Blue Cross/Blue ShieldThe specialist contracts with the managed care plan for an entire episode of care.

          

  3. Formal referralPrimary care physician informs the patient and phones the referring physician that the patient is being referred for an appointment.

          

  4. Silent PPO PlanTraditional insurance; insured pays monthly premiums and 100% of medical bills until deductible is met.

          

  5. Verbal ReferralPhysician informs the patient and telephones the referring physician that the patient is being referred for an appointment.