Reference no: EM132236101
1. A “carve-out” refers to :
a. A set of medical services that are taken out of the basic arrangement.
b. A set of licenses required by an HMO
c. A set process of obtaining and reviewing plan benefits by an outside agency
d. A set amount of money a taken out prior to coverage verification
2. A highly important section of the contract outlines the provider’s agreement to accept as payment in full for medical services provided to MCO member. This is commonly referred to as:
a. Hold harmless
b. Indemnity
c. Medically Necessary
d. Copayment
3. FFS is nearly the only form of reimbursement in PPOs, service plans and indemnity plans.
True
False
4. Non-physicians providers may play an important role in the management of ___________.
a. Credentialing process
b. Chronically ill patients
c. Acute ill patients
d. Malpractice cases
5. Hospital based physicians are a unique type of specialist that fall into one of four specialties
a. Nurse practitioner, Pathologist, Radiologist and Anesthesiology
b. Hospitalist, Midwife, Radiologist and Pathologist
c. Anesthesiology, Pathologist, Hospitalist and Radiology
d. Radiology, Anesthesiology, Pathology and phlebotomists
6. Capitation involves fixed payments made on:
a. EMR
b. P4P
c. FFS
d. PMPM
7. It is the presence of a ___________that defines an MCO.
a. Physician
b. Service plan
c. Primary care physician
d. Contract
8. An example of a non physicians or a midlevel practitioner.
a. Emergency room nurse
b. Cardiologist
c. Primary care physician
d. Physician assistant