NWCA study guide exam questions with correct answers.

NWCA study guide exam questions with correct
answers

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