Reference no: EM132236106
1. The three key elements to the classic quality management are structure, process and ___________.
a. Assessment
b. Verification
c. Outcome
d. Utilization
2. The most common type of relative value scale is
a. FFS
b. PMPM
c. RBRVS
d. IDS
3. MCO = Contract + _____________
a. Network of Providers
b. Qualification Credentials
c. Physicians and Specialists
d. Hospitals and PCP
4. An MCO has an obligation to verify that the physician in its network meet the professional standards that it has established for its participating providers. TRUE or FALSE
True
False
5. Disease management and case management focus on conditions that are acute, inexpensive to treat or both.
True
False
6. HMOs frequently pay their physicians, especially PCPs, according to some form of:
a. Fee for service arrangement
b. Risk-based arrangement
c. Diagnosis related group arrangement
7. Although FFS remains the most common form of physician reimbursement, capitation is a powerful and popular option for PPOs.
True
False
8. The national provider identifier replaced all other forms of provider identifiers, such as the Medicare universal provider identification numbers (UPIN), Blue Cross and Blue Shield numbers, Health plan provider number, Medicaid numbers and so forth.
True
False
9. The central point of a contract is that MCO has an obligation to verify that physician in its network meet the professional standards that it has established for participating providers. This process is referred to as:
a. Provider data bank
b. Auditing
c. Credentialing
d. Capitation
10. Dr Paul Elwood coined the term:
a. Managed Care Organization
b. Health Maintenance Organization
c. Health Risk Appraisals
d. Demand Management