HI chp 3
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| This defines employer contributions and asks employees to be more responsible for healthcare decisions and cost-sharing. | CDHP: Consumer-directed Health Plan | ||||
| List two ways that MCOs impact a practice's administration. | Pages 53 and 54 in textbook | ||||
| Who is responsible for supervising and coordinating healthcare services for enrollees and approves referrals to specialists and inpatient hospital admissions? | Primary care provider | ||||
| This is a private, not-for-profit organization that assesses the quality of managed care plans in the US and releases the data to the public for consideration when selecting a managed care plan. | NCQA: National Committee for Quality Assurance | ||||
| This plan allows participants to enroll in a relatively inexpensive high-deductible insurance plan and a tax-deductible savings account is opened to cover current and future medical expenses. | HSA: Health saving account | ||||
| What is the term when the PCP provides essential healthcare services at the lowest possible cost, avoiding nonessential care, and referring patients to specialists. | Gatekeeper | ||||
| What does the acronym EPO mean? | Exclusive Provider Organization | ||||
| What does the acronym IDS mean? | Integrated Delivery System | ||||
| What does the acronym HMO mean? | Health Maintenance Organization | ||||
| What does the acronym POS mean? | Point-of-service Plan | ||||
| What does the acronym PPO mean? | Preferred Provider Organization | ||||
| What does the acronym PCP mean? | Primary Care Provider | ||||
| This is a review of the appropriateness and necessity of care provided to patients prior to administration of care. | Prospective review | ||||
| This is a review of the appropriateness and necessity of care provided after administration of care. | Retrospective review | ||||
| This is a review for medical necessity of tests and procedures ordered during an inpatient hospitalization. | Concurrent review | ||||
| What reimburses providers for individual healthcare services rendered? | Fee-for-service | ||||
| What is it called when a provider accepts pre-established payments for providing healthcare services to enrollees over a period of time? | Capitation | ||||
| What are payments made directly or indirectly to healthcare providers to encourage them to reduce or limit services? | Physician incentives | ||||
| What is needed prior to scheduling elective surgery? That is, a second physician is asked to evaluate the necessity of surgery. | SSO: Second Surgical Opinion | ||||
| What in a managed-care contract would prevent providers from discussing all treatment options with patients? | Gag clause | ||||
| What is a voluntary process that a healthcare facility or organization undergoes to demonstrate that it has met standards beyond those required by law? | Accreditation |
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Created by:
YTIMBC
on 2011-05-20