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Health Insurance C3
Health Insurance Chapter 3
| Question | Answer |
|---|---|
| ____________ defines employer contributions and ask employees to be more responsible for healthcare decisions and cost sharing. | CDHP (Consumer-directed health plans) |
| Managed care is being challenged by the growth of ____________. | CDHP (Consumer-directed health plans) |
| ___________ reimburse providers for individual healthcare services rendered. | Fee for Service Plans |
| Managed care is financed accroding to a method called _______________. | Capitation |
| __________ is responsible for supervising and coordinating healthcare services for enrollees and approves referrals to specialists and inpatient hospital admissions. | Primary Care Provider |
| _____________ revies appropriateness and neccessity of care provided to patients prior to administration of care. | Prospective Review |
| ____________ revies the appropriateness and necessity of care provided to patients after the administration of care. | Retrospective Review |
| __________ is a review for medical necessity of inpatient care prior to the patient's admission. | Preadmission Certification |
| _____________ is a review for medical necessity of tests and procedures ordered during an inpatient hospitialization. | Concurrent Review |
| _________ involves arranging appropriate healthcare services for the discharged patient. | Discharge Planning |
| A second physician is asked to evaluate the necessity of surgery and recommend the most economical, appropriate facility in which to perform the surgery. | Second Surgical Opinion |
| _________ include payments made directly or indirectly to healthcare providers to encourage them to reduce or limit services as to save money for the managed care plan. | Physician Incentives |
| EPO | Exclusive provider organization |
| IDS | Integrated delivery system |
| HMO | Healthcare maintenance organization |
| POS | Point-of-service plan |
| PPO | Preferred provider organization |
| _______ is a voluntary process that a healthcare facility or organization undergoes to to demonstrate that it has met the standards beyond those required by law. | Accreditation |
| NCQA | National Committee for Quality Assurance |
| A tax exempt account offered by employers which indiviuals use to pay healthcare bills. Inexpensive high deductible health plan and a health savings account is opened up to pay for current or future medical bills. | HSA (Health Savings Account) |
| _________ is a review that grants prior approval for reimbursement of a healthcare service. | Preauthorization |
| Effects of managed care on a physician's practice. | Seperate bookkeeping for each capitated plan to ensure finacial viability of the contract. |
Created by:
tlindrose
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