A) affordable care organization. B) acute care organization. C) accountable care organization. D) assurance care organization. A) affordable care organization. B) acute care organization. C) accountable care organization. D) assurance care organization.

Exam 3: Understanding Managed Care: Medical Contracts and Ethics

When a managed care organization (MCO) examines a physician's background for evidence of fraud or criminal activity, this is part of the process known as ________.

(Short Answer)

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Question 61

In plans that require the primary care physician (PCP) to play a gatekeeper role, the PCP is given incentives to:

(Multiple Choice)

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Question 62

With respect to National Committee for Quality Assurance (NCQA) accreditation:

(Multiple Choice)

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Question 63

A payer that is contractually obligated to make payment for medical services on behalf of the covered person can be:

(Multiple Choice)

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Question 64

All of the following regarding the Patient's Bill of Rights are true EXCEPT:

(Multiple Choice)

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Question 65

Match the following -A compensation arrangement in which a provider is paid a per-member-per-month fee

(Multiple Choice)

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Question 66

In MCOs, the business aspects of healthcare are not being controlled by:

(Multiple Choice)

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Question 67

What is the key component of an accountable care organization?

(Multiple Choice)

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Question 68

A ________ contract is another form of a legal agreement between the provider and the patient under which the patient pays the provider an annual fee or retainer.

(Short Answer)

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Question 69

Providers are likely to agree to discounted fee-for-service contracts because they result in a(n):

(Multiple Choice)

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Question 70

Managed care organizations (MCOs) develop a network by contracting with:

(Multiple Choice)

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Question 71

A managed care contract should clearly state all of the following EXCEPT:

(Multiple Choice)

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Question 72

ACOs are a group of insurance providers.

(True/False)

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Question 73

ACO stands for:

(Multiple Choice)

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Question 74

The Patient's Bill of Rights under the Affordable Care Act put an end to insurance companies limiting choice of doctors.

(True/False)

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(72)

Question 75

Providers are not required to sign a contract with a managed care plan in order to become part of the plan's provider network.

(True/False)

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(83)

Question 76

A managed care contract that involves payment through capitation provides incentives for physicians to emphasize preventive care.

(True/False)

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Question 77

A managed care organization will contract with physicians, laboratories, pharmacies, hospitals, clinics, and other healthcare facilities in building a provider network.

(True/False)

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Question 78

The contract provision that states a physician cannot seek payment from a patient under a managed care contract in relation to any benefit penalties that were applied based on a utilization review decision is:

(Multiple Choice)

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(63)

Question 79

A medical office specialist cannot be held liable for fraudulent billing practices if told to do so by a physician.

(True/False)

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(83)

Question 80

Showing 61 - 80 of 101

When a managed care organization (MCO) examines a physician's background for evidence of fraud or criminal activity, this is part of the process known as ________.

In plans that require the primary care physician (PCP) to play a gatekeeper role, the PCP is given incentives to:

With respect to National Committee for Quality Assurance (NCQA) accreditation:

A payer that is contractually obligated to make payment for medical services on behalf of the covered person can be:

All of the following regarding the Patient's Bill of Rights are true EXCEPT:

Match the following -A compensation arrangement in which a provider is paid a per-member-per-month fee

In MCOs, the business aspects of healthcare are not being controlled by:

What is the key component of an accountable care organization?

A ________ contract is another form of a legal agreement between the provider and the patient under which the patient pays the provider an annual fee or retainer.

Providers are likely to agree to discounted fee-for-service contracts because they result in a(n):

Managed care organizations (MCOs) develop a network by contracting with:

A managed care contract should clearly state all of the following EXCEPT:

ACOs are a group of insurance providers.

ACO stands for:

The Patient's Bill of Rights under the Affordable Care Act put an end to insurance companies limiting choice of doctors.

Providers are not required to sign a contract with a managed care plan in order to become part of the plan's provider network.

A managed care contract that involves payment through capitation provides incentives for physicians to emphasize preventive care.

A managed care organization will contract with physicians, laboratories, pharmacies, hospitals, clinics, and other healthcare facilities in building a provider network.

The contract provision that states a physician cannot seek payment from a patient under a managed care contract in relation to any benefit penalties that were applied based on a utilization review decision is:

A medical office specialist cannot be held liable for fraudulent billing practices if told to do so by a physician.

Introduction to Professional Billing and Coding Careers

Understanding Managed Care: Insurance Plans

Introduction to the Health Insurance Portability and Accountability Act Hipaa

ICD-10 Cm Medical Coding

Introduction to CPT and Place of Coding Services

Coding Procedures and Services

Hcpcs Coding and Compliance

Auditing

Physician Medical Billing

Hospital Medical Billing

Medicare Medical Billing

Medicaid Medical Billing

Tricare Medical Billing

Explanation of Benefits and Payment Adjudication

Refunds and Appeals

Workers Compensation

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