NWCA Study Guide with all Correct & 100% Verified
Answers |Latest Version |Already Graded A+
Managed Care Organization (MCO) ✔Correct Answer-Combines functions of health insurance,
delivery of care and administration
Exclusive Provider Organization (EPO) ✔Correct Answer-Services covered only if use doctors,
specialists or hospitals in plans network (except in hospitals)
Health Maintenance Organization (HMO) ✔Correct Answer-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) ✔Correct Answer-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) ✔Correct Answer-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) ✔Correct Answer-Pay less if use providers in plans network.
Can use providers outside of network without a referral for N additional cost.
DHHS stands for ✔Correct Answer-Department of health and human services
Medicare Administrative Contractor (MAC) is ✔Correct Answer-A private health care insurer
awarded geographic jurisdiction to process medicare A y B
Medicare A covers ✔Correct Answer-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 ✔Correct Answer-Medically necessary services, preventative services
Part C is ✔Correct Answer-Medicare advantage plan, often a HMO, OR PPO, or other health plan
that also offers prescription drug coverage, get A,B, and D
When health care providers agree to accept Medicare reimbursement, they sign an agreement with
MACs ✔Correct Answer-Agree to accept MAC payment as full, called accepting assignment
DRG assignment ✔Correct Answer-A system of payment rates to health care providers in which
illnesses are categorized into related types
Medicare severity diagnosis related groups (MS-DRG) are used for ✔Correct Answer-
Reimbursement decisions
UB04 also called c,s-1450 is ✔Correct Answer-The insurance form used by inpatient facilities for
claims submissions
Answers |Latest Version |Already Graded A+
Managed Care Organization (MCO) ✔Correct Answer-Combines functions of health insurance,
delivery of care and administration
Exclusive Provider Organization (EPO) ✔Correct Answer-Services covered only if use doctors,
specialists or hospitals in plans network (except in hospitals)
Health Maintenance Organization (HMO) ✔Correct Answer-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) ✔Correct Answer-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) ✔Correct Answer-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) ✔Correct Answer-Pay less if use providers in plans network.
Can use providers outside of network without a referral for N additional cost.
DHHS stands for ✔Correct Answer-Department of health and human services
Medicare Administrative Contractor (MAC) is ✔Correct Answer-A private health care insurer
awarded geographic jurisdiction to process medicare A y B
Medicare A covers ✔Correct Answer-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 ✔Correct Answer-Medically necessary services, preventative services
Part C is ✔Correct Answer-Medicare advantage plan, often a HMO, OR PPO, or other health plan
that also offers prescription drug coverage, get A,B, and D
When health care providers agree to accept Medicare reimbursement, they sign an agreement with
MACs ✔Correct Answer-Agree to accept MAC payment as full, called accepting assignment
DRG assignment ✔Correct Answer-A system of payment rates to health care providers in which
illnesses are categorized into related types
Medicare severity diagnosis related groups (MS-DRG) are used for ✔Correct Answer-
Reimbursement decisions
UB04 also called c,s-1450 is ✔Correct Answer-The insurance form used by inpatient facilities for
claims submissions
