Exam 2: Understanding Managed Care: Insurance Plans

If a member in a health maintenance organization (HMO) sees a specialist without a referral from his or her primary care physician (PCP), the HMO will not pay for the service.

Before managed care most doctors were paid directly by:

Health maintenance organization (HMO) plans add a point-of-service (POS) option to:

The majority of payments received in a medical facility come from insurance carriers.

What are the differences between an individual and group insurance contract?

List some of the advantages of managed care.

All of the following are government plans under the Affordable Care Act EXCEPT:

By accepting lower payments from MCOs, physicians are forced to see more patients each day in order to:

Which of the following plan types does not use a network of providers?

Which of the following is a characteristic of a preferred provider organization (PPO)?

Insurance information obtained by the medical office specialist:

Group insurance is issued to an employer to provide coverage for:

A managed care organization (MCO) collects data on care delivery, such as identifying the percentage of children in a health maintenance organization (HMO) who have been immunized.

Disadvantages of managed care include all of the following EXCEPT:

A point-of-service (POS) plan allows members to choose a health maintenance organization (HMO) or preferred provider organization (PPO) once a year at open enrollment.

All of the following are types of health maintenance organizations (HMOs) EXCEPT the:

Match the following -The type of managed care plan in which members have financial incentives, such as lower copayments, when they obtain care from network providers

HIPAA was created in 1999.

Examples of individuals who would qualify for COBRA include:

Match the following -The type of health maintenance organization (HMO) that does not require a referral from a PCP to see a specialist