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5 Written questions

5 Matching questions

  1. ERISA
  2. Case Rate Pricing
  3. POS
  4. Indemnity Plan
  5. Direct referral
  1. a - Employee Retirement Income Security Act
  2. b The specialist contracts with the managed care plan for an entire episode of care.
  3. c - Point-of-service Option or Plan
  4. d An authorization request form is completed and signed by the physician and handed to the patient.
  5. e Traditional insurance; insured pays monthly premiums and 100% of medical bills until deductible is met.

5 Multiple choice questions

  1. Transfer the sickest high-cost patients to other physicians so that the provider appears as a low utilizer
  2. Managed Care Organizations
  3. Is the largest pioneer in private insurance company in the United States.
  4. Physician informs the patient and telephones the referring physician that the patient is being referred for an appointment.
  5. - 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.

5 True/False questions

  1. Self-referralPhysician informs the patient and telephones the referring physician that the patient is being referred for an appointment.

          

  2. Stop-Loss- Point-of-service Option or Plan

          

  3. Physician Provider Group (PPG)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.

          

  4. HMO- Quality Improvement Organization

          

  5. Silent PPO 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.