Exam 7: Unraveling the Mysteries of Managed Care

Although there are several advantages to the managed care type of healthcare,there are no disadvantages.

A system designed to determine the medical necessity and appropriateness of a requested medical service or procedure is a/an:

A predominant,standard-setting nonprofit organization that evaluates and accredits healthcare organizations in the United States is ____________________.

HIPAA requires all employers to provide healthcare coverage for their employees.

With many MCOs,the enrollee typically pays a small fee up front called a ____________________when visiting his or her PCP.

Which federal act,passed in 1996,is intended to improve the efficiency of healthcare delivery,reduce administrative cost,and protect patient privacy?

MCOs tend to focus on ____________________ care,or keeping the patient well,thus avoiding expensive treatment later on.

An independent,not-for-profit organization that evaluates and accredits healthcare organizations and is considered the predominant standards-setting and accrediting body in healthcare in the United States.

With a point-of-service type HMO,patients are allowed to go outside the plan and use any provider they choose.

In which type of managed care organization may services be furnished at discounted rates if the members receive their healthcare from member providers but pay a higher out-of-pocket cost when going outside the organization?