Quiz: Managed Health care Insurance Questions!

15 Questions | Total Attempts: 1055

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Quiz: Managed Health care Insurance Questions!

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Questions and Answers
  • 1. 
    The intent of managed health care was to
    • A. 

      Dramatically improve the healthcare delivery system in the united states

    • B. 

      Have employees of a managed care organization provide patient care

    • C. 

      Replace fee- for-service plans with affordable, quality care to healthcare consumers

    • D. 

      Retrospectively reimburse patient for healthcare services provided

  • 2. 
    What term best describes those who receive managed healthcare plan services?
    • A. 

      Employees

    • B. 

      Enrollees

    • C. 

      Payers

    • D. 

      Providers

  • 3. 
    The medical center received a $100,000 capitation payment in January to cover healthcare cost of 150 managed care enrollees. By the following January,$80,000 had been expended to cover services provided. The remaining $20.000 is
    • A. 

      Distributed equally among the 150 enrollees

    • B. 

      Retained by the medical center as profit

    • C. 

      Submitted to the managed care organization

    • D. 

      Turned over to the federal government

  • 4. 
    A non profit organization that contracts with and acquires the clinical and business assets of physician practices is called?
    • A. 

      Medical foundation

    • B. 

      Medicare risk programs

    • C. 

      Physician-hospital organizations

    • D. 

      Triple opttion plans

  • 5. 
    A ________ is responsible for supervising and coordinating healthcare services for enrollees
    • A. 

      Case manager

    • B. 

      Primary care provider

    • C. 

      Third party administrator

    • D. 

      Utilization review manager

  • 6. 
    The term that describes requirements created by accreditation organizations is
    • A. 

      Laws

    • B. 

      Mandates

    • C. 

      Regulations

    • D. 

      Standards

  • 7. 
    Arranging appropriate healthcare services for discharged patients 
    • A. 

      Pre-admissions review

    • B. 

      Preauthorizaton

    • C. 

      Concurrent review

    • D. 

      Discharge planning

  • 8. 
    Review for medical necessity for inpatient care prior to admission
    • A. 

      Concurrent review

    • B. 

      Preauthorization

    • C. 

      Pre-admission review

    • D. 

      Discharge planning

  • 9. 
    Review for medical necessity of tests/procedures ordering during inpatient hospitalization
    • A. 

      Discharge planning

    • B. 

      Preauthorization

    • C. 

      Concurrent review

    • D. 

      Pre-admission review

  • 10. 
    Grants prior approval for reimbursement of a healthcare service 
    • A. 

      Pre-admission review

    • B. 

      Preauthorization

    • C. 

      Concurrent review

    • D. 

      Discharge planning

  • 11. 
    Contract network of healthcare providers that provide care to subscribers for a discounted fee
    • A. 

      EPO

    • B. 

      IDS

    • C. 

      HMO

    • D. 

      POS

    • E. 

      PPO

  • 12. 
    Organization of affiliated providers sites that offer joint healthcare services to subscribers
    • A. 

      EPO

    • B. 

      IDS

    • C. 

      HMO

    • D. 

      POS

    • E. 

      PPO

  • 13. 
    Provides benefits to subscribers who are required to receive services from network providers
    • A. 

      EPO

    • B. 

      IDS

    • C. 

      PPO

    • D. 

      POS

    • E. 

      HMO

  • 14. 
    Provides comprehensive healthcare services to voluntarily enrolled members on a prepaid basis
    • A. 

      EPO

    • B. 

      IDS

    • C. 

      HMO

    • D. 

      POS

    • E. 

      PPO

  • 15. 
    Patients are free to use the managed care panel or self refer to non-managed care providers
    • A. 

      EPO

    • B. 

      IDS

    • C. 

      HMO

    • D. 

      POS

    • E. 

      PPO

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