Health Insurance Chap 7 & Ess. Chap 5 & Pharm. Chap 23
99 Questions
| Total Attempts: 75
Review week 3 mod 6
Questions and Answers
- 1.A healthcare delivery system that controls utilization and cost of services while providing enrollees access to quality cost effective healthcare is
- A.
Commercial care
- B.
Managed care
- C.
Systemized care
- D.
Preventive care
- 2.Individuals who are members of a managed care plan are commonly referred to as
- A.
Patients
- B.
Employees
- C.
Enrollees
- D.
Subscribers
- 3.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
- A.
HMO
- B.
FFS
- C.
AMA
- D.
PPO
- 4.A specific provider who oversees the total healthcare treatment of an individual enrolled in certain managed care plans is a
- A.
Participating provider
- B.
Primary care physician
- C.
Principal care provider
- D.
Treatment administrator
- 5.A relatively small out of pocket dollar amount that a member of a managed care plan typicallys pays up front is a
- A.
Copayment
- B.
Deductible
- C.
Premium
- D.
Compensation
- 6.A healthcare provider trained in a specific medical specialty is a
- A.
Specialist
- B.
Consultant
- C.
Counselor
- D.
Participating provider
- 7.A multispeciality practice in which healthcare services are provided within the building complex owned by the health maintenance organization (HMO) is referred to as a/an
- A.
IPA
- B.
Staff model
- C.
Network model
- D.
Direct contact model
- 8.A type of HMO whereby services are provided by outpatient networks composed of individual healthcare providers who supply all necessary patient care is a/an
- A.
IPA
- B.
Network model
- C.
Point of service
- D.
Direct contact model
- 9.An advantage of managed care organizations (MCOs) is that their aim is to keep their enrollees healthy which is commonly referred to as
- A.
Health options
- B.
Preventive care
- C.
All inclusive care
- D.
Defensive treatment
- 10.A private nonprofit organization that accredits healthcare plans based on evaluation of the quality of care given to plan members is the
- A.
AMA
- B.
NUCC
- C.
Joint commission
- D.
NCQA
- 11.An independent not for profit organization that sets standards for healthcare in the united states and accredits most major hospitals is the
- A.
AMA
- B.
NUCC
- C.
Joint commission
- D.
NCQA
- 12.The formal term for a written complaint submitted by an individual covered by a special plan or policy is called a
- A.
Letter
- B.
Grievance
- C.
Complaint
- D.
Dispatch
- 13.A system designed to determine the medical necessity and appropriateness of a requested medical service or procedure is a/an
- A.
Appeal
- B.
Petition
- C.
Utilization review
- D.
Needs evaluation
- 14.A procedure required by most healthcare plans before a provider carries out specific procedures or treatment is a/an
- A.
Appeal
- B.
Grievance
- C.
Equalization
- D.
Prequthorization
- 15.A procedure required by most healthcare plans before a provider carries out specific procedures or treatment is a/an
- A.
Appeal
- B.
Grievance
- C.
Equalization
- D.
Preauthorization
- 16.A request by a healthcare provider for his/her patient to be evaluated or treated by a specialist is a
- A.
Referral
- B.
Consultation
- C.
Confirmation
- D.
Preauthorization
- 17.This federal act, passed in 1996 is intended to improve the efficiency of healthcare delivery, reduce administrative cost and protect patient privacy
- A.
HCFA
- B.
HIPPA
- C.
EMTLA
- D.
COBRA
- 18.One primary function of a managed care organization (MCO) is to establish a list of covered benefits tied to managed care rules
- A.
True
- B.
False
- 19.One of the more popular types of MCO in this country is the preferred provider organization (PPO)
- A.
True
- B.
False
- 20.Under the federal HMO act an entity must have five characteristics to call itself an HMO
- A.
True
- B.
False
- 21.Members of an HMO normally pay only a small fee (called a copayment) each time they visit their healthcare provider
- A.
True
- B.
False
- 22.With a point of service type HMO patients are allowed to go outside the plan and use any provider they choose
- A.
True
- B.
False
- 23.One advantage of an MCO is that it never has to be accredited
- A.
True
- B.
False
- 24.Precertification is a process people must go through to become eligible to join an HMO
- A.
True
- B.
False
- 25.A referral is exactly the same as a consultation
- A.
True
- B.
False
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