5 Written questions
5 Matching questions
- Authorization Request Log
- Identification Card
- Verbal Referral
- Silent PPO Plan
- a Card given to each enrollee of a managed care plan include and list patient's the name and member number
- b - 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.
- c - Point-of-service Option or Plan
- d Physician informs the patient and telephones the referring physician that the patient is being referred for an appointment.
- e To be used as a system for tracing referral of patients for diagnostic testing, procedures, and consultations.
5 Multiple choice questions
- The patient refers himself or herself to a specialist, the patient may be required to inform the primary care physician.
- - Quality Improvement Organization
- Plan that allows members to select from three choices; HMOs, PPOs, or "Traditional" indemnity insurance.
- - Health Plan Employer Data Information Set
- An authorization request is required by the MCO contract to determine medical necessary, this can be done over the phone, or completed authorization form mailed, transmitted via fax or email.
5 True/False questions
COBRA → - Consolidated Omnibus Budget Reconciliation Act
MCO → - Exclusive Provider Organization.
Turfing → 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.
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.
Churning → Transfer the sickest high-cost patients to other physicians so that the provider appears as a low utilizer