5 Written questions
5 Matching questions
- Direct referral
- Ross-Loos Medical Group
- Case Rate Pricing
- Blue Cross/Blue Shield
- a The specialist contracts with the managed care plan for an entire episode of care.
- b Is the largest pioneer in private insurance company in the United States.
- c An authorization request form is completed and signed by the physician and handed to the patient.
- d - America's oldest privately owned prepaid medical group.
- e 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.
5 Multiple choice questions
- Card given to each enrollee of a managed care plan include and list patient's the name and member number
- - Health Maintenance Organization.
- Plan that allows members to select from three choices; HMOs, PPOs, or "Traditional" indemnity insurance.
- - 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.
- 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
MCO → - Managed Care Organizations
ERISA → - Employee Retirement Income Security Act
IPA → - Preferred Provider Organization
Tertiary care → - Employee Retirement Income Security Act
Stop-Loss → - 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)