FREE QUIZ BOWL AND STUDY GAMES ABOUT MANAGED

PDF Download

FREE QUIZ BOWL AND STUDY GAMES ABOUT MANAGED

CARE EXAM QUESTIONS

Actual Qs and Ans Expert-Verified Explanation

This Exam contains:

-Guarantee passing score -20 Questions and Answers -format set of multiple-choice -Expert-Verified Explanation

Question 1: What is the common type of payment arrangement in a managed care

contract?

Answer:

Discount fee-for-service, usual and customary, and capitated payments.

Question 2: What were the federal funds used for in the HMO act of 1973?

Answer:

To promote health maintenance organizations, HMOs

Question 3: What does the schedule of benefits section include?

Answer:

A list of medical services covered under the insured's policy and the amount paid.

Question 4: A medical office specialist works as a liaison between ?

Answer:

The provider and the patient, the provider and the carrier

Question 5: What did the employers do to avoid higher costs of healthcare in the past?

Answer:

Hire temporary employees who will not be eligible for health insurance benefits to avoid high costs.

Question 6: Who qualifies for COBRA benefits?

Answer:

If the insured works for a business of 20 or more employees and leaves his job or is laid off. Children who are full time students.

Question 7: What are utilization guidelines used for?

Answer:

To deny medical services to patients, so providers would determine the medical necessity of tests and services before providing them.

Question 8: What is the term used to refer to fees in an insurance contract?

Answer:

UCR, Usual, customary, and reasonable fees Question 9: During the credentialing process, a managed care organization evaluates what about the provider?

Answer:

Medical credentials, service fees, and workplace environment.Question 10: What is the organization that awards accreditation to managed care organizations?

Answer:

National Committee for Quality Assurace (NCQA)

Question 11: What does RBRVS stand for?

Answer:

Resource-based relative value scale.Question 12: What is the most restrictive type of managed care plan:

Answer:

HMO

Question 13: A managed care contract is considered a legal document between whom?

Answer:

The provider and the health care management, Question 14: What is the fee schedule in managed care contracts increasingly based on?

Answer:

Medicare's resource-based relative value scale RBRVS with a different conversion factor

Question 15: What are the goals of managed care?

Answer:

To control healthcare costs and manage quality care

Question 16: What does PMPM stand for in managed care contracts?

Answer:

Per member per month payment based capitation

Question 17: Which managed care plan type does not use a network of providers?

Answer:

Indemnity Plan

Question 18: How many employees must the employer have to offer COBRA benefits?

Answer:

20 or more employees.Question 19: To determine the amount due from a patient, what must the medical office specialist know?

Answer:

Must know the billed allowed amount, contractual amount and patient co-pay portion.Question 20: What type of insurance coverage provides protection against a certain type of accident or illness?

Answer:

Special Risk