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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. |