Help
Options
Didn't know it?
click below
click below
Knew it?
click below
click below
Don't Know
Remaining cards (0)
Know
retry
shuffle
restart
0:00
Embed Code - If you would like this activity on your web page, copy the script below and paste it into your web page.
Normal Size Small Size show me how
Normal Size Small Size show me how
Med Insurance Pro
Exam ch.3 and for other insurance class.
| Question | Answer |
|---|---|
| enrollees or subscribers are also known as the | policyholders |
| for 50 cents a month the western clinic in tacoma washington, offered medical services to lumber mill owners and their employees. | 1910 |
| the first nationally recognized health maintenance organization (HMO) Kaiser-Permanente was created. | 1955 |
| authorized grants and loans, defined a federally qualified HMO, required most employers with more than 25 employees to offer it | Health Maintenance Organization Assistance Act of 1973 |
| modified the HMO act of 1973, created Medicare risk programs, defined risk contact, and definted competitive medical plan (CMP) | tax equite and fiscal responsibility ace of 1982 |
| state managed care legislation, medical savings accounts pilot program, and balanced budget act | 1997 |
| is responsible for supervising and coordinating health care services for enrollees and approves referrals to specialists and inpatient hospital admissions(except in emergencies) | primary care provider |
| includes activities that assess the quality of care provided in a health care setting. | quality assurance program |
| contains data regarding a managed care plan's quality, utilization, customer satisfaction, administrative effectiveness, financial stability, and cost control. | the report card |
| which is a review for medical necessity of inpatient care prior to the patients admission | preadmission certification |
| submits written confirmation, authorizing treatment to the provider. | case manager |
| which preven providers from discussing all treatment options | gag clause |
| include payments made directly or indirectly to health care providers to serve as encouragement to reduce or limit services | physician incentives |
| a fee paid by the patient to the provider at the time health care servies are rendered. | copayments |
| to create flexibility in managed care plans some HMOs and preferred provider organizations have implemented a | point of service plan (POS) |
| if the enrollee sees a non-HMO panel specialist without a referralfrom the primary care physician this is known as.. | self-refferal |
| Health care services are provided to subscribers by physicians employed by the HMO . Premiums and other revenue are paid to the HMO. Usually all ambulatory services are provided within HMO corporate buildings. | Staff Model HMO |
| contracted health services are delivered to subscribers by physicians who remain in their independent office settings. | Individual practice association IPA HMO |
| which is usually offered either by a single insurance plan or as a joint venture among two or more insurance carriers provides subscribers or employees witha choice of HMO, PPO< or traditional health insurance plans. | triple option plan |
| when a number of people are grouped for insurance purposes | risk pool |
| include many choices that provide individuals with an incentive to control the costs of health benefits and health care. | consumor-directed health plans (CDHPs) |
| each provider is paid a fixed amount per month to provide only the care that individual needs from that provider. | customized sub-capitation plan (CSCP) |
| tax-exempt accounts offered by employers with any number of employees which individuals use to pay health care bills by contributing funds | flexible spending account (FSA) |
| enroll a relatively inexpensive high-deductable plan, money deposited (and earnings) is a tax deferred, money can be withdrawn but 15 percent penalty | health savings account HSA health savings security account HSSA |
| first state to enact legislation allowing consumers to sue an HMO for medical malpractice. | texas |
| triple option plans are intended to prevent the problem of covering members who are sicker than the general population | adverse selection |
| triple option plan is also called a... | cafeteria plan |
| accreditation organizations develop standards (requirements) that are reviewed during a | survey |
| as an HMO that meets federal eligibility requirements for a Medicare risk contract but is not licensed as a federally qualified plan. | competitive medical plan |
| is a physician or health care facility under contract to the managed care plan. | network provider |
| contracted health services are delivered to subscribers by physicians who remain in their independent office settings. The ___ is an intermediary that negotiates the HMO contract,receives,magages the capitation payment from the HMO. | IPA independent practice association |
| what has nothing to do with predetermined standards? | JCAHO |
| Accreditiation is not a voluntary process that a health care facility or organization undergoes. | false |
| both state and government embrace some form of managed care in order to control the costs of insurance. | true |
| national commitee only conduct surveys for health care facilities for quality assurance | false |
| managed care plans are easier to tend to than fee for service plans. | false they are not, managed care was the people who took the place of fee for service anyway) |
| most managed care is financed through capitation payments. | true |
| is a second surgical opinion required? | no, (false on test i beleive) |
| a percentage of health care coses to be paid by the patient for health care services is known as the | coinsurance |
| staff employed by the HMO? | true |
| peradmission certification is prior to patient admission | true |
| medical savings acount, flexible spending acount, and etc are all examples of | income directed plans. |
Created by:
jrw4274