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1. Steps used to control costs of managed care include :Answer:
Bundled codes Capitation
Payer and Provider to agree on reasonable payment
2. DRG is used to classify:Answer: Inpatient admissions for the purpose
of reimbursing hospitals for each case in a given category w/a negotiated
fixed fee, regardless of the actual costs incurred
3. Identify the various types of private health plan
coverage:Answer: HMO Conventional
PPO and POS
HDHP/SO plans - high-deductible health plans with a savings option; Private
- Include higher patient out-of-pocket expenditures for treatments that can
serve to reduce utilization/costs.
4. Managed care organizations (MCO) exist primarily in four
forms:Answer: Health Maintenance Organizations (HMO)
Preferred Provider Organizations
(PPO) Point of Service (POS)
Organizations Exclusive Provider
Organizations (EPO)
5. Identify the various types of government sponsored health coverage-
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