Chapter 7, 8 MSEC 124 Questions With Complete Solutions
24-hour notice prior to an inpatient hospitalization for all
hospitalizations unless emergency Correct Answers
preauthorization
A managed care system composed of individual healthcare
providers who offer healthcare services for HMO and non-HMO
patient but maintain their own offices and identities is called
a(n)
a.Network Model.
b. Open-panel IPA
c. Direct-contact model.
d. POS plan Correct Answers b. Open-Panel IPA
A multipsecialty group practice in which all healthcare services
are provided within the building(s( owned by the HMO is called
a:
a. staff model.
b. group model.
c. network model.
d. direct contact model Correct Answers a. staff model
A person's adjusted gross income plus any tax exempt social
security, interest or other income. Correct Answers Modified
adjusted gross income
A plan that allows patients to use HMO provider or go outside
the plan and pay a higher copayment and deductible is a (n)
a. Network model.
b. Open-end HMO
,c. Direct-contact model.
d. Full service PPO Correct Answers b. Open-end HMO
A primary care physician , typically who is a family practice
clinician, internist or a pediatrician is known in HMO settings
as? Correct Answers Gatekeeper
A procedure required by third-party payers that requires
permission before a provider can carry out specific procedure
and treatments is a(n)
a. A referral.
b. Certification.
c. Preauthorization.
d. A "medical right to know" Correct Answers c.
Preauthorization
A reimbursement system in which healthcare providers receive a
fixed fee for every patient enrolled in the plan, regardless of how
many or few services the patient uses is called a(n)
a. Usual, customary and reasonable.
b. Capitation.
c. misallocation.
d. allowed fee. Correct Answers b. capitation
A specific provider who oversees an HMO member's total
healthcare treatment is called a(n)
a. Specific provider
b. Attending physician.
c. Complete care provider
d. Primary care physician Correct Answers d. Primary Care
Physician
, A specific provider who oversees an HMO member's total
healthcare treatment? Correct Answers PCP
A state option that provides individuals with disabilities who are
eligible for nursing homes and other institutional settings with
options to receive community based services is called
a. community first choice option.
b. elderly community housing program.
c. medicaid integrity option.
d. qualified medicaid beneficiary option. Correct Answers a.
community first choice option
a symptom or illness brought on unintentionally by something
that a physician says or does Correct Answers iatrogentic
effects
A system that is designed to determine the medical necessity and
appropriateness of a medical service, procedure, or hospital
admition. Correct Answers Utilization review.
A transfer of claim data from one insurer to another insurer
Correct Answers crossover claims
A type of managed care organization that provides medicare
beneficiaries with alternatives to original medicare is a(n)
a. HMO
b. POS
c. PSO
d. IPA Correct Answers c. PSO
24-hour notice prior to an inpatient hospitalization for all
hospitalizations unless emergency Correct Answers
preauthorization
A managed care system composed of individual healthcare
providers who offer healthcare services for HMO and non-HMO
patient but maintain their own offices and identities is called
a(n)
a.Network Model.
b. Open-panel IPA
c. Direct-contact model.
d. POS plan Correct Answers b. Open-Panel IPA
A multipsecialty group practice in which all healthcare services
are provided within the building(s( owned by the HMO is called
a:
a. staff model.
b. group model.
c. network model.
d. direct contact model Correct Answers a. staff model
A person's adjusted gross income plus any tax exempt social
security, interest or other income. Correct Answers Modified
adjusted gross income
A plan that allows patients to use HMO provider or go outside
the plan and pay a higher copayment and deductible is a (n)
a. Network model.
b. Open-end HMO
,c. Direct-contact model.
d. Full service PPO Correct Answers b. Open-end HMO
A primary care physician , typically who is a family practice
clinician, internist or a pediatrician is known in HMO settings
as? Correct Answers Gatekeeper
A procedure required by third-party payers that requires
permission before a provider can carry out specific procedure
and treatments is a(n)
a. A referral.
b. Certification.
c. Preauthorization.
d. A "medical right to know" Correct Answers c.
Preauthorization
A reimbursement system in which healthcare providers receive a
fixed fee for every patient enrolled in the plan, regardless of how
many or few services the patient uses is called a(n)
a. Usual, customary and reasonable.
b. Capitation.
c. misallocation.
d. allowed fee. Correct Answers b. capitation
A specific provider who oversees an HMO member's total
healthcare treatment is called a(n)
a. Specific provider
b. Attending physician.
c. Complete care provider
d. Primary care physician Correct Answers d. Primary Care
Physician
, A specific provider who oversees an HMO member's total
healthcare treatment? Correct Answers PCP
A state option that provides individuals with disabilities who are
eligible for nursing homes and other institutional settings with
options to receive community based services is called
a. community first choice option.
b. elderly community housing program.
c. medicaid integrity option.
d. qualified medicaid beneficiary option. Correct Answers a.
community first choice option
a symptom or illness brought on unintentionally by something
that a physician says or does Correct Answers iatrogentic
effects
A system that is designed to determine the medical necessity and
appropriateness of a medical service, procedure, or hospital
admition. Correct Answers Utilization review.
A transfer of claim data from one insurer to another insurer
Correct Answers crossover claims
A type of managed care organization that provides medicare
beneficiaries with alternatives to original medicare is a(n)
a. HMO
b. POS
c. PSO
d. IPA Correct Answers c. PSO
