Exam 2: Understanding Managed Care: Insurance Plans

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Point-of-service (POS) plans are becoming more popular because they offer more flexibility and freedom of choice than do standard health maintenance organizations (HMOs).

(True/False)

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Question 81

What is the HMO Act of 1973?

(Essay)

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Question 82

The subscriber in a health maintenance organization (HMO) can also be called a(n): A)employer or policyholder. B)policyholder or member. C)member or provider. D)patient or carrier.

(Short Answer)

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Question 83

The type of health maintenance organization (HMO) plan that involves contracting with individual physicians to create a healthcare delivery system is a(n): A)group model. B)individual practice association (IPA) model. C)network model. D)staff model.

(Short Answer)

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Question 84

The federal law that makes it possible for most people to continue their group health coverage for a period of time after leaving a job is called __________ .

(Short Answer)

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Question 85

Features of a preferred provider organization (PPO) includes which of the following? A)It contracts with healthcare providers to form a network. B)It offers members financial incentives to use network providers. C)A PCP arranges, provides, coordinates, and authorizes all aspects of a member's healthcare. D)It employs salaried physicians who treat members in facilities it owns and operates.

(Short Answer)

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Question 86

Because of managed care, providers have been required to revamp the way they operate their businesses and methods of patient care.

(True/False)

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Question 87

A physician who coordinates a patient's care and refers patients to specialists is a(n): A)preferred provider physician (PPP). B)referring gatekeeper. C)primary care physician (PCP). D)primary physician coordinator (PPC).

(Short Answer)

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Question 88

Managed care is a method of controlling healthcare costs and the delivery of care.

(True/False)

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Question 89

Preferred provider organization (PPO) members pay less out of pocket for medical services from a contracted provider than from a non-network provider.

(True/False)

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Question 90

Which of the following is true of an exclusive provider organization (EPO)?

(Multiple Choice)

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Question 91

During the first half of the 20th century, most doctors were paid directly by: A)preferred provider organizations (PPOs). B)health maintenance organizations (HMOs). C)government programs. D)individuals.

(Short Answer)

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Question 92

Showing 81 - 92 of 92

Point-of-service (POS) plans are becoming more popular because they offer more flexibility and freedom of choice than do standard health maintenance organizations (HMOs).

What is the HMO Act of 1973?

The subscriber in a health maintenance organization (HMO) can also be called a(n): A)employer or policyholder. B)policyholder or member. C)member or provider. D)patient or carrier.

The type of health maintenance organization (HMO) plan that involves contracting with individual physicians to create a healthcare delivery system is a(n): A)group model. B)individual practice association (IPA) model. C)network model. D)staff model.

The federal law that makes it possible for most people to continue their group health coverage for a period of time after leaving a job is called __________ .

Because of managed care, providers have been required to revamp the way they operate their businesses and methods of patient care.

A physician who coordinates a patient's care and refers patients to specialists is a(n): A)preferred provider physician (PPP). B)referring gatekeeper. C)primary care physician (PCP). D)primary physician coordinator (PPC).

Managed care is a method of controlling healthcare costs and the delivery of care.

Preferred provider organization (PPO) members pay less out of pocket for medical services from a contracted provider than from a non-network provider.

Which of the following is true of an exclusive provider organization (EPO)?

During the first half of the 20th century, most doctors were paid directly by: A)preferred provider organizations (PPOs). B)health maintenance organizations (HMOs). C)government programs. D)individuals.

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Understanding Managed Care: Medical Contracts and Ethics

Hipaa: Health Insurance Portability and Accountability Act of 1996

ICD-9-CM Medical Coding

ICD-10-CM Medical Coding

Introduction to Cpt and Place of Service Coding

Coding Procedures and Services

Hcpcs and Coding 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

Electronic Medical Claims Processing

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