Chapter 7 Multiple Choice
Quiz yourself by thinking what should be in
each of the black spaces below before clicking
on it to display the answer.
Help!
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| 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
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| Individuals belonging to a managed healthcare plan are referred to as | enrollees
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| The two most common types of MCOs are | HMO and PPO
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| A specific provider who oversees the HMO members total healthcare treatment is called a | PCP
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| The amount of money a pt has to pay out-of-pocket per visit is | copayment
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| When an individual first enrolls in an HMO he chooses a | PCP
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| Most managed healthcare plans emphasize | preventative care
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| A multispecialty group practice where all healthcare services are provided within the buildings owned by the HMO is called a | Staff model
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| 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
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| 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
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| 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
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| 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
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| 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
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| If a particular medical service or procedure is determined not to be "medically necessary" a pt may file a | Grievance
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| A procedure required by third-party payers that requires permission before a provider can carry out specific procedures and treatments is | pre-authorization
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