NWCA STUDY GUIDE QUESTIONS
WITH ALL CORRECT ANSWERS!!
Managed Care Organization (MCO) ...ANSWER...Combines functions of health insurance, delivery of care
and administration
Exclusive Provider Organization (EPO) ...ANSWER...Services covered only if use doctors, specialists or
hospitals in plans network (except in hospitals)
Health Maintenance Organization (HMO) ...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) ...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) ...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) ...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 ...ANSWER...Department of health and human services
Medicare Administrative Contractor (MAC) is ...ANSWER...A private health care insurer awarded
geographic jurisdiction to process medicare A y B
WITH ALL CORRECT ANSWERS!!
Managed Care Organization (MCO) ...ANSWER...Combines functions of health insurance, delivery of care
and administration
Exclusive Provider Organization (EPO) ...ANSWER...Services covered only if use doctors, specialists or
hospitals in plans network (except in hospitals)
Health Maintenance Organization (HMO) ...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) ...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) ...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) ...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 ...ANSWER...Department of health and human services
Medicare Administrative Contractor (MAC) is ...ANSWER...A private health care insurer awarded
geographic jurisdiction to process medicare A y B
