FREE AND STUDY GAMES ABOUT CHAPTER 3 INSURANCE

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FREE AND STUDY GAMES ABOUT CHAPTER 3 INSURANCE

EXAM QUESTIONS

Actual Qs and Ans Expert-Verified Explanation

This Exam contains:

-Guarantee passing score -17 Questions and Answers -format set of multiple-choice -Expert-Verified Explanation

Question 1: Fee-For-Service

Answer:

reimburse providers for individual health care services rendered, managed care is financed according to a method called capitation, where providers accept preestablished payments for providing health care services to enrollees over a period of time Question 2: Organization of affiliated providers' sites that offer joint health care services to subscribers.

Answer:

IDS

Question 3: PCP serves as a ____

Answer:

gatekeeper Question 4: A nonprofit organization that contracts with and acquires the clinical and business assets of physician practices is called a

Answer:

medical foundation.

Question 5: Utilization Management

Answer:

a method of controlling health care costs and quality of care Question 6: The Medical Center received a $100,000 capitation payment in January to cover the health care costs of 150 managed care enrollees. By the following January, $80,000 had been expended to cover services provided. The remaining $20,000 is

Answer:

retained by the Medical Center as profit.Question 7: Which is a voluntary process that a health care facility or organization undergoes to demonstrate that it has met standards beyond those required by law?

Answer:

accreditation Question 8: Which define employer contributions and ask employees to be more responsible for health care decisions and cost-sharing?

Answer:

consumer-directed health plans Question 9: Contracted network of health care providers that provide care to subscribers for a discounted fee.

Answer:

PPO Question 10: Which is responsible for supervising and coordinating health care services for enrollees and approves referrals to specialists?

Answer:

primary care provider (PCP)

Question 11: Gatekeeper

Answer:

providing essential health care services at the lowest possible cost, avoiding nonessential care, and referring patients to specialists.

Question 12: The term that describes requirements created by accreditation organizations is

Answer:

standards Question 13: Provides benefits to subscribers who are required to receive services from network providers.

Answer:

EPO Question 14: Patients can use the managed care panel of providers (paying discounted health care costs) or self-refer to out-of-network providers (and pay higher health care costs).

Answer:

POS Question 15: Which administrative procedure should a medical practice follow when it contracts with a managed care organization (MCO)?

Answer:

Maintain separate bookkeeping systems for each capitated plan.

Question 16: Managed Care Organization (MCO)

Answer:

is responsible for the health of a group of enrollees and can be a health plan, hospital, physician group, or health system

Question 17: The intent of managed health care was to

Answer:

replace fee-for-service plans with affordable, quality care to health care consumers.