Chapter 3 Insurance Word Scramble

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Question	Answer
The intent of managed health care was to	replace fee-for-service plans with affordable, quality care to health care consumers.
The Medical Center received a $100,000 capitation payment in January to cover the health care costs of 150 managed care enrollees. By the following January, $80,000 had been expended to cover services provided. The remaining $20,000 is	retained by the Medical Center as profit.
A nonprofit organization that contracts with and acquires the clinical and business assets of physician practices is called a	medical foundation.
Which is responsible for supervising and coordinating health care services for enrollees and approves referrals to specialists?	primary care provider (PCP)
The term that describes requirements created by accreditation organizations is	standards
Which administrative procedure should a medical practice follow when it contracts with a managed care organization (MCO)?	Maintain separate bookkeeping systems for each capitated plan.
Which is a voluntary process that a health care facility or organization undergoes to demonstrate that it has met standards beyond those required by law?	accreditation
Which define employer contributions and ask employees to be more responsible for health care decisions and cost-sharing?	consumer-directed health plans
Contracted network of health care providers that provide care to subscribers for a discounted fee.	PPO
Organization of affiliated providers' sites that offer joint health care services to subscribers.	IDS
Provides benefits to subscribers who are required to receive services from network providers.	EPO

Patients can use the managed care panel of providers (paying discounted health care costs) or self-refer to out-of-network providers (and pay higher health care costs).	POS
Managed Care Organization (MCO)	is responsible for the health of a group of enrollees and can be a health plan, hospital, physician group, or health system
Fee-For-Service	reimburse providers for individual health care services rendered, managed care is financed according to a method called capitation, where providers accept preestablished payments for providing health care services to enrollees over a period of time
PCP serves as a ____	gatekeeper
Gatekeeper	providing essential health care services at the lowest possible cost, avoiding nonessential care, and referring patients to specialists.
Utilization Management	a method of controlling health care costs and quality of care

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