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5 Written questions

5 Matching questions

  1. Withhold
  2. Utilization Review (UR)
  3. HMO
  4. COBRA
  5. Patient Information Letter
  1. a - Inform managed care subscriber in writing what is expected from them and what they can expect in turn.

    - Also known as Waiver of Liability in Medicare program is called Advance Beneficiary Notice (ABN).
  2. b - Consolidated Omnibus Budget Reconciliation Act
  3. c - A portion of the monthly capitation payment to physicians retained by the HMO until the end of the year to create an incentive for efficient care.

    - If the physician exceeds utilization norms, he or she will not receive it.
  4. d - 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. e - Health Maintenance Organization.

5 Multiple choice questions

  1. 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. - Preferred Provider Organization
  3. - Point-of-service Option or Plan
  4. Primary care physician informs the patient and phones the referring physician that the patient is being referred for an appointment.
  5. Utilization Review

5 True/False questions

  1. Identification CardCard given to each enrollee of a managed care plan include and list patient's the name and member number


  2. ERISA- Employee Retirement Income Security Act


  3. ChurningWhen 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. Blue Cross/Blue ShieldIs the largest pioneer in private insurance company in the United States.


  5. Authorization Request LogTo be used as a system for tracing referral of patients for diagnostic testing, procedures, and consultations.