5 Written questions
5 Matching questions
- Utilization Review (UR)
- Patient Information Letter
- 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).
- b - Consolidated Omnibus Budget Reconciliation Act
- 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.
- 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.
- e - Health Maintenance Organization.
5 Multiple choice questions
- 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.
- - Preferred Provider Organization
- - Point-of-service Option or Plan
- Primary care physician informs the patient and phones the referring physician that the patient is being referred for an appointment.
- Utilization Review
5 True/False questions
Identification Card → Card given to each enrollee of a managed care plan include and list patient's the name and member number
ERISA → - Employee Retirement Income Security Act
Churning → 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.
Blue Cross/Blue Shield → Is the largest pioneer in private insurance company in the United States.
Authorization Request Log → To be used as a system for tracing referral of patients for diagnostic testing, procedures, and consultations.