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

99 Questions | Total Attempts: 75

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Health Insurance Quizzes & Trivia

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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