Health Insurance Chap 7 & Ess. Chap 5 & Pharm. Chap 23

A "hybird" type of managed care (also called an open ended HMO) that allows patients to use either their HMO provider or go outside the plan and use a provider of their choices is a/ an _______________

A request by a healthcare provider for a patient under his/her care to be treated by another provider usually a specialist is a _______ (hint total care is often transferred)

When a patient is sent to another provider (often a specialist) with the intent of rendering an expert opinion only this is a ___________consultation  (hint total care is not transferred)

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

__________________ pertains to medical necessity and appropriateness only and does not in all instances guarantee payment

A process used by health insurance companies to control health care costs similar to prequthorization is

The ________________ model HMO is similar to an IPA except the organization contracts directly with individual providers

Symptoms of corneal abrasion or ulcer include pain, redness, tearing, and sometimes visual impairment

• True

• False

Serious otitis media may be either acute or chronic

• True

• False

A referral is exactly the same as a consultation

• True

• False

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

The private not for profit organization that is dedicated to improving healthcare quality and is frequently referred to as the managed care "watch dog" is ___________

HMOs normally do not have _____________ or plan limits

Managed care has had little impact on healthcare in general in the united states

• True

• False

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

• True

• False

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

• True

• False

A predominant standard setting nonprofit organization that evaluates and accredits healthcare organizations in the united states is the ______________

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

The internal lens of the eye is elastic and therefore can focus images both near and far

• True

• False

Keratitis is frequently caused by an infection of herpes simplex virus

• True

• False

Chronic open end glaucoma results from a malfunction of the drainage system which causes intraocular pressure to be raised

• True

• False

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

• True

• False

The only treatment that cures otosclerosis is a surgical procedure called stapedectomy

• True

• False

A cholesteatoma and mastoiditis can both be the result of a neglected otitis media

• True

• False

Macular degeneration is

• Caused by degenerative changes in the retina

• Usually related to aging

• Both of the above

• None of the above

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

• HCFA

• HIPPA

• EMTLA

• COBRA

Sensorineural hearing loss that is caused by damage to the cochlea is irreversible, therefore prevention is essential

• True

• False

Glaucoma only occurs after age 60

• True

• False

Members of an HMO normally pay only a small fee (called a copayment) each time they visit their healthcare provider

• True

• False

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

• Participating provider

• Primary care physician

• Principal care provider

• Treatment administrator

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

• Copayment

• Deductible

• Premium

• Compensation

An advantage of managed care organizations (MCOs) is that their aim is to keep their enrollees healthy which is commonly referred to as

• Health options

• Preventive care

• All inclusive care

• Defensive treatment

A request by a healthcare provider for his/her patient to be evaluated or treated by a specialist is a

• Referral

• Consultation

• Confirmation

• Preauthorization

Treatment of refractive errors of the eye might include

• Laser surgery

• Contact lenses

• Eyeglasses

• All of the above

Inflammatory infections of the hair follicles of the eyelid are called

• Styes

• Entropion

• Keratitis

• None of the above

Infection or inflammation in the semicircular canals is called

• Cholesteatoma

• Labyrinthitis

• Otomycosis

• Presbycusis

Which of the following might be prescribed to aid in smoking cessation

• Doxepin (sinequan)

• Naloxone(narcan)

• Bupropion(zyban)

• Buspirone (buspar)

A healthcare provider trained in a specific medical specialty is a

• Specialist

• Consultant

• Counselor

• Participating provider

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

• True

• False

The middle ear is normally air filled

• True

• False

Toxic levels of lithium (lithane) may be associated with which of the following symptoms

• Constipation and loss of appetite

• Decreased urination and fever

• Diarrhea and fine hand tremors

• Increased appetite and sedation

The peripheral nervous system referes to the nervous structures outside of the

• Brain

• Central nervous system

• Spine

• Extremities

The formal term for a written complaint submitted by an individual covered by a special plan or policy is called a

• Letter

• Grievance

• Complaint

• Dispatch

A procedure required by most healthcare plans before a provider carries out  specific procedures or treatment is a/an

• Appeal

• Grievance

• Equalization

• Preauthorization

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

• True

• False

When reporting a craniectomy/craniotomy procedure it is common to also code _____ procedures

• Grafting

• Catheterization

• Intubation

• Excision

Weaning patients from selective serotonin re-uptake inhibitors (SSRIs) will reduce the likelihood of which of the following post treatment symptoms

• Hypomanic episodes and increased energy

• Anxiety and crying spells

• Sedation and decreased appetite

• Increased appetite and excessive thirst

An inflammation of the thin transparent membrane covering the visible portion of the sclera and lining the inside of the eyelids results in

• Conjunctivitis

• Choroiditis

• Cornea abrasion

• Lens distortion