NWCA STUDY GUIDE COMPLETE WITH
CORRECT ANSWERS
\.Managed Care Organization (MCO) - ANSWERS✔-Combines functions
of health insurance, delivery of care and administration
\.Exclusive Provider Organization (EPO) - ANSWERS✔-Services covered
only if use doctors, specialists or hospitals in plans network (except in
hospitals)
\.Health Maintenance Organization (HMO) - ANSWERS✔-Limits
coverage to care from doctors who work for or contract with the HMO,
generally won't cover out of network care except in emergency. May
require to live or work in its service area.
\.Point of Service (POS) - ANSWERS✔-Pay less if you use doctors, and
other health care providers that belong to the plans network, required
to get a referral from primary care doctor in order to see specialist
\.Quality Improvement Organization (QIO) - ANSWERS✔-Physician can
hose whether or not accept Medicare patients, who are seeking non
, medical services, signs an agreement and May sign a participating
provider agreement(PAR)
\.Preferred Provider Organization (PPO) - ANSWERS✔-Pay less if use
providers in plans network. Can use providers outside of network
without a referral for N additional cost.
\.DHHS stands for - ANSWERS✔-Department of health and human
services
\.Medicare Administrative Contractor (MAC) is - ANSWERS✔-A private
health care insurer awarded geographic jurisdiction to process medicare
AyB
\.Medicare A covers - ANSWERS✔-Hospital care, skilled nursing facility
care, nursing home, ( as long as custodial care isn't the only type of care
needed), hospice, o e health services
\.Part b covers - ANSWERS✔-Medically necessary services, preventative
services
CORRECT ANSWERS
\.Managed Care Organization (MCO) - ANSWERS✔-Combines functions
of health insurance, delivery of care and administration
\.Exclusive Provider Organization (EPO) - ANSWERS✔-Services covered
only if use doctors, specialists or hospitals in plans network (except in
hospitals)
\.Health Maintenance Organization (HMO) - ANSWERS✔-Limits
coverage to care from doctors who work for or contract with the HMO,
generally won't cover out of network care except in emergency. May
require to live or work in its service area.
\.Point of Service (POS) - ANSWERS✔-Pay less if you use doctors, and
other health care providers that belong to the plans network, required
to get a referral from primary care doctor in order to see specialist
\.Quality Improvement Organization (QIO) - ANSWERS✔-Physician can
hose whether or not accept Medicare patients, who are seeking non
, medical services, signs an agreement and May sign a participating
provider agreement(PAR)
\.Preferred Provider Organization (PPO) - ANSWERS✔-Pay less if use
providers in plans network. Can use providers outside of network
without a referral for N additional cost.
\.DHHS stands for - ANSWERS✔-Department of health and human
services
\.Medicare Administrative Contractor (MAC) is - ANSWERS✔-A private
health care insurer awarded geographic jurisdiction to process medicare
AyB
\.Medicare A covers - ANSWERS✔-Hospital care, skilled nursing facility
care, nursing home, ( as long as custodial care isn't the only type of care
needed), hospice, o e health services
\.Part b covers - ANSWERS✔-Medically necessary services, preventative
services
