5 Written questions
5 Matching questions
- Verbal referral
- a Transfer the sickest high-cost patients to other physicians so that the provider appears as a low utilizer
- b - Exclusive Provider Organization.
- c Primary care physician informs the patient and phones the referring physician that the patient is being referred for an appointment.
- d - National Committee for Quality Assurance, accredits HMOs.
- e Utilization Review
5 Multiple choice questions
- Physician informs the patient and telephones the referring physician that the patient is being referred for an appointment.
- Traditional insurance; insured pays monthly premiums and 100% of medical bills until deductible is met.
- - Health Plan Employer Data Information Set
- An authorization request form is completed and signed by the physician and handed to the patient.
- At the time service is rendered.
5 True/False questions
Withhold → - Health Maintenance Organization.
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.
Patient Information Letter → - 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).
Tertiary care → - Employee Retirement Income Security Act
Preauthorization → Plan that allows members to select from three choices; HMOs, PPOs, or "Traditional" indemnity insurance.