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5 Written questions

5 Matching questions

  1. Correct procedure to collect a co-payment on a MCPlan
  2. PPO
  3. COBRA
  4. Self-referral
  5. MCO
  1. a At the time service is rendered.
  2. b The patient refers himself or herself to a specialist, the patient may be required to inform the primary care physician.
  3. c - Preferred Provider Organization
  4. d - Managed Care Organizations
  5. e - Consolidated Omnibus Budget Reconciliation Act

5 Multiple choice questions

  1. Traditional insurance; insured pays monthly premiums and 100% of medical bills until deductible is met.
  2. - Quality Improvement Organization
  3. 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.
  4. Transfer the sickest high-cost patients to other physicians so that the provider appears as a low utilizer
  5. - Health Maintenance Organization.

5 True/False questions

  1. ERISA- Employee Retirement Income Security Act

          

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

          

  3. 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.

          

  4. POS- Preferred Provider Organization

          

  5. Case Rate PricingTraditional insurance; insured pays monthly premiums and 100% of medical bills until deductible is met.