HCA 540 FINAL EXAM QUESTIONS & ANSWERS
What are the five different types of health maintenance organizations HMOs - Answer -
1. Staff Model
2. Group Model
3. IPA
4. Network Model
5. Mixed Model
Staff Model - Answer -A type of closed panel HMO in which physicians are employees
of the HMO and they see patients in the HMO facility.
Group Model - Answer -an HMO that contracts with a single multi-specialty medical
group to provide care to the HMOs membership. They can do work with HMO or non-
HMO members.
IPA - Answer -a group of independent physicians who have their own offices and then
group together to service their HMO contracts. No pooling together.
Network Model - Answer -an HMO model that contracts with multiple physicians groups
to provide service to the HMO members
Mixed Model - Answer -can be a mixture of any of the other HMO models
Health Maintenance Organization (HMO) - Answer -A health care system that assumes
or shares both financial and delivery risks associated with providing comprehensive
medical services to a voluntary enrolled population. this is in a certain geographical area
with a fixed or prepaid fee.
HIPAA - Answer -was created in 1996 and worked on improving "portability" of
coverage in health insurance. Mandated coverage for women giving birth to have two
days over coverage or four if they have a C-section. Said that mental and physical
health should have the same status. Medical records should be accurate and belong to
the patient.
Prepaid Group Practice - Answer -these first appeared in the 1890s that set a payment
to the physician to get a fee on a regular basis also called capitation. The fee was being
charged regardless if the service was being used.
Indemnity health insurance - Answer -type of health insurance that was traditionally
provided by blue cross blue shield and other commercial insurance companies before
MC. This is like typcal insurance where the person pays a premium and then is charges
by service not by a fee to the doctors.
What are the five different types of health maintenance organizations HMOs - Answer -
1. Staff Model
2. Group Model
3. IPA
4. Network Model
5. Mixed Model
Staff Model - Answer -A type of closed panel HMO in which physicians are employees
of the HMO and they see patients in the HMO facility.
Group Model - Answer -an HMO that contracts with a single multi-specialty medical
group to provide care to the HMOs membership. They can do work with HMO or non-
HMO members.
IPA - Answer -a group of independent physicians who have their own offices and then
group together to service their HMO contracts. No pooling together.
Network Model - Answer -an HMO model that contracts with multiple physicians groups
to provide service to the HMO members
Mixed Model - Answer -can be a mixture of any of the other HMO models
Health Maintenance Organization (HMO) - Answer -A health care system that assumes
or shares both financial and delivery risks associated with providing comprehensive
medical services to a voluntary enrolled population. this is in a certain geographical area
with a fixed or prepaid fee.
HIPAA - Answer -was created in 1996 and worked on improving "portability" of
coverage in health insurance. Mandated coverage for women giving birth to have two
days over coverage or four if they have a C-section. Said that mental and physical
health should have the same status. Medical records should be accurate and belong to
the patient.
Prepaid Group Practice - Answer -these first appeared in the 1890s that set a payment
to the physician to get a fee on a regular basis also called capitation. The fee was being
charged regardless if the service was being used.
Indemnity health insurance - Answer -type of health insurance that was traditionally
provided by blue cross blue shield and other commercial insurance companies before
MC. This is like typcal insurance where the person pays a premium and then is charges
by service not by a fee to the doctors.
