Exam 7: Unraveling the Mysteries of Managed Care

The future of managed care is clear-cut;it is predicted that it will totally eliminate traditional healthcare in 10 years.

A relatively small out-of-pocket dollar amount that a member of a managed care plan typically pays up front is:

A group of healthcare providers working under one umbrella to provide medical services at a discount to the individuals who participate in the plan is referred to as a/an:

List the three main objectives of HIPAA.

One primary function of a managed care organization (MCO)is to establish a list of covered benefits tied to managed care rules.

A ____________________ is used in managed care plans to reduce unnecessary inpatient/outpatient services.

A request by a healthcare provider for a patient under his or her care to be treated by another provider,usually a specialist,is a/an ____________________.(Hint: Total care is often transferred.)

One of the major goals of the Affordable Care Act is to provide quality,affordable care for all Americans.

A specific provider who oversees the entire care and treatment of a patient in an HMO is called a ___________.

A healthcare provider trained in a particular medical specialty is a:

Managed care has had little impact on healthcare in general in the United States.

HMOs normally do not have ____________________ or plan limits.

One advantage of an MCO is that it never has to be accredited.

Individuals who are members of a managed care plan are commonly referred to as:

A specific provider who oversees the total healthcare treatment of an individual enrolled in certain managed care plans is generally referred to as a:

The purpose of a consultation usually is to obtain an expert opinion only,and care of the patient is not relinquished to the consulting provider.

One of the more popular types of MCO in this country is the preferred provider organization (PPO).

The ____________________ model HMO is similar to an IPA,except that the organization contracts directly with individual providers.

Managed care is a healthcare system where insurance companies attempt to control _____ healthcare.

____________________ pertains to medical necessity and appropriateness only and does not,in all instances,guarantee payment.