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HIT Chapter 7 MC

Chapter 7 Multiple Choice

QuestionAnswer
An organized interrelated system of people and facilities that communicate with one another and work together as a unit is commonly referred to as a Network
Individuals belonging to a managed healthcare plan are referred to as enrollees
The two most common types of MCOs are HMO and PPO
A specific provider who oversees the HMO members total healthcare treatment is called a PCP
The amount of money a pt has to pay out-of-pocket per visit is copayment
When an individual first enrolls in an HMO he chooses a PCP
Most managed healthcare plans emphasize preventative care
A multispecialty group practice where all healthcare services are provided within the buildings owned by the HMO is called a Staff model
An HMO that contracts with independent, multispecialty physician groups that provide all healthcare services to its members and usually share the same facility support staff. medical records, and equipment is called a Group Model
A reimbursement system in which healthcare providers receive a fixed fee for every patient enrolled in the plan, regardless of how many or few services the pt uses capitation
A managed care system composed of individual healthcare providers who offer healthcare services for HMO and non-HMO pt but maintain their own offices and identities is called an Open-panel IPA
A plan that allows pts to use the HMO provider or go outside the plan and pay a higher copayment and deductible is a POS plan
A system designed to determine the medical necessity and appropriateness of a requested medical services procedure or hospital admission prior concurrent or retrospective to the event is called Utilization Review
If a particular medical service or procedure is determined not to be "medically necessary" a pt may file a Grievance
A procedure required by third-party payers that requires permission before a provider can carry out specific procedures and treatments is pre-authorization
Created by: 1279370503 on 2009-12-07



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