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5 Written questions

5 Matching questions

  1. Direct referral
  2. Silent PPO Plan
  3. Preauthorization
  4. POS
  5. Stop-Loss
  1. a 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.
  2. b An authorization request form is completed and signed by the physician and handed to the patient.
  3. c - Point-of-service Option or Plan
  4. d - 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)
  5. e - 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.

5 Multiple choice questions

  1. 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.
  2. - America's oldest privately owned prepaid medical group.
  3. At the time service is rendered.
  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. Patient Information LetterCard given to each enrollee of a managed care plan include and list patient's the name and member number

          

  2. Triple OptionPlan that allows members to select from three choices; HMOs, PPOs, or "Traditional" indemnity insurance.

          

  3. QIO- Health Maintenance Organization.

          

  4. 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.

          

  5. Case Rate PricingThe specialist contracts with the managed care plan for an entire episode of care.