5 Written questions
5 Matching questions
- Correct procedure to collect a co-payment on a MCPlan
- a At the time service is rendered.
- b The patient refers himself or herself to a specialist, the patient may be required to inform the primary care physician.
- c - Preferred Provider Organization
- d - Managed Care Organizations
- e - Consolidated Omnibus Budget Reconciliation Act
5 Multiple choice questions
- Traditional insurance; insured pays monthly premiums and 100% of medical bills until deductible is met.
- - Quality Improvement Organization
- 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.
- Transfer the sickest high-cost patients to other physicians so that the provider appears as a low utilizer
- - Health Maintenance Organization.
5 True/False questions
ERISA → - Employee Retirement Income Security Act
Stop-Loss → - Point-of-service Option or Plan
Withhold → - 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.
POS → - Preferred Provider Organization
Case Rate Pricing → Traditional insurance; insured pays monthly premiums and 100% of medical bills until deductible is met.