Question 1

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

Accepted Answer

A) True 
 B)False

Question 2

MCOs develop a network by contracting with:
A)physicians.
B)facilities.
C)pharmacies.
D)all of the above.

Accepted Answer

The answer of MCOs develop a network by contracting with:
A)physicians.
B)facilities.
C)pharmacies.
D)all...

Question 3

A medical office specialist works as a liaison between:
A)the provider and patient.
B)the provider and carrier.
C)the patient and employer.
D)the employer and carrier.

Accepted Answer

The answer of A medical office specialist works as a...

Question 4

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

Accepted Answer

A) True 
 B)False

Question 5

Which of the following is NOT a common type of payment arrangement in a managed care contract?
A)Discounted fee-for-service
B)Usual and customary
C)Capitation
D)Per case

Accepted Answer

The answer of Which of the following is NOT a...

Question 6

A contract with which of the following payment terms can result in an increased financial risk to the provider?
A)Capitation
B)Percentage of premiums
C)Fee-for-service
D)Discounted fee-for-service

Accepted Answer

The answer of A contract with which of the following...

Question 7

A managed care contract specifies covered services, reimbursement amounts, and the method of __________ for the contracted physician.

Accepted Answer

The answer of A managed care contract specifies covered services,...

Question 8

Under a contract based on a per-case or per-visit rate of compensation, the provider is paid a predetermined rate for each:
A)enrolled patient.
B)episode of care.
C)diagnosis code.
D)service provided.

Accepted Answer

The answer of Under a contract based on a per-case...

Question 9

The Patient's Bill of Rights was adopted in 1998 by the:
A)National Committee for Quality Assurance (NCQA).
B)Centers for Medicare and Medicaid Services (CMS).
C)U.S. Advisory Commission on Consumer Protection and Quality in the Health Care Industry.
D)U.S. Surgeon General.

Accepted Answer

The answer of The Patient's Bill of Rights was adopted...

Question 10

What types of payment arrangements can be made in managed care contracts?

Accepted Answer

The answer of What types of payment arrangements can be...

Question 11

In order to receive National Committee for Quality Assurance (NCQA) accreditation, a managed care organization (MCO) must demonstrate that it has a thorough credentialing process.

Accepted Answer

A) True 
 B)False

Question 12

A managed care contract is considered a legal document between the:
A)provider and insurer.
B)provider and patient.
C)patient and insurer.
D)insurer and employer.

Accepted Answer

The answer of A managed care contract is considered a...

Question 13

"Medically efficient" used in contract language may have the same meaning as "medically necessary."

Accepted Answer

A) True 
 B)False

Question 14

Most managed care contracts allow an unlimited timeframe for submitting claims.

Accepted Answer

A) True 
 B)False

Question 15

Through a credentialing process, a managed care organization (MCO) evaluates a provider's:
A)medical credentials.
B)service fees.
C)workplace environment.
D)all of the above.

Accepted Answer

The answer of Through a credentialing process, a managed care...

Question 16

In the Patient's Bill of Rights, information disclosure provides patients with the right to information that is:
A)easily understood in English only.
B)translated into all languages spoken in the United States.
C)easily understood in English, French, and Spanish.
D)explained with assistance for non-English-speakers, people with disabilities, or those who need help for other reasons.

Accepted Answer

The answer of In the Patient's Bill of Rights, information...

Question 17

Determination of which of two or more health plans will provide benefits as primary or secondary payer is known as coordination of benefits.

Accepted Answer

A) True 
 B)False

Question 18

Match between columns
                        Premises: A compensation arrangement in which a provider is paid a per-member-per-month fee
A provider who is not under contract with a managed care plan
A licensed healthcare professional who has entered into an agreement to provide covered services to covered individuals
An insurance company, third-party administrator, or self-insured health benefit plan that is contractually obligated to make payments on behalf of covered persons
The determination of which health plan will pay for covered services as primary or secondary payer
Healthcare services provided to covered persons under the terms of the benefit plan
An individual who is an insured, enrolled participant or enrolled dependent under a benefit plan
Contract issued by a payer under which a covered person may be entitled to covered services
The amount a covered person is required to pay at the time of service
Covered services provided by a physician that are consistent with the physician’s training, licensure, and scope of practice

Accepted Answer

The Answer of participating provider and capitation and copayment and is...

Question 19

Discounted fee-for-service arrangements can discourage a provider from ordering multiple tests and providing a higher level of services.

Accepted Answer

A) True 
 B)False

Question 20

A provider who enters into a contract with an MCO is referred to as a(n):
A)active provider.
B)MCO provider.
C)participating provider.
D)permanent provider.

Accepted Answer

The answer of A provider who enters into a contract...

Exam 3: Understanding Managed Care: Medical Contracts and Ethics

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

MCOs develop a network by contracting with: A)physicians. B)facilities. C)pharmacies. D)all of the above.

A medical office specialist works as a liaison between: A)the provider and patient. B)the provider and carrier. C)the patient and employer. D)the employer and carrier.

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

Which of the following is NOT a common type of payment arrangement in a managed care contract? A)Discounted fee-for-service B)Usual and customary C)Capitation D)Per case

A contract with which of the following payment terms can result in an increased financial risk to the provider? A)Capitation B)Percentage of premiums C)Fee-for-service D)Discounted fee-for-service

A managed care contract specifies covered services, reimbursement amounts, and the method of __________ for the contracted physician.

Under a contract based on a per-case or per-visit rate of compensation, the provider is paid a predetermined rate for each: A)enrolled patient. B)episode of care. C)diagnosis code. D)service provided.

The Patient's Bill of Rights was adopted in 1998 by the: A)National Committee for Quality Assurance (NCQA). B)Centers for Medicare and Medicaid Services (CMS). C)U.S. Advisory Commission on Consumer Protection and Quality in the Health Care Industry. D)U.S. Surgeon General.

What types of payment arrangements can be made in managed care contracts?

In order to receive National Committee for Quality Assurance (NCQA) accreditation, a managed care organization (MCO) must demonstrate that it has a thorough credentialing process.

A managed care contract is considered a legal document between the: A)provider and insurer. B)provider and patient. C)patient and insurer. D)insurer and employer.

"Medically efficient" used in contract language may have the same meaning as "medically necessary."

Most managed care contracts allow an unlimited timeframe for submitting claims.

Through a credentialing process, a managed care organization (MCO) evaluates a provider's: A)medical credentials. B)service fees. C)workplace environment. D)all of the above.

Determination of which of two or more health plans will provide benefits as primary or secondary payer is known as coordination of benefits.

Match the following:

Discounted fee-for-service arrangements can discourage a provider from ordering multiple tests and providing a higher level of services.

A provider who enters into a contract with an MCO is referred to as a(n): A)active provider. B)MCO provider. C)participating provider. D)permanent provider.