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HIT Chapter 7 MC
Chapter 7 Multiple Choice
| Question | Answer |
|---|---|
| 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 |
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