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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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