Ch 7: Review Test Flashcards
The Changing Face of Managed Care
An organized, interrelated system of people and facilities that communicate with one another and work together as a unit is commonly referred to as a ____?
Network
Individuals belonging to a managed healthcare plan are commonly referred to as what?
Enrollees
What are the two most common types of MCOs?
- HMO (Health Maintenance Organization)
- PPO (Preferred Provider Organization)
A specific provider who oversees an HMO member’s total healthcare treatment is called a ____?
Primary care physician (PCP)
The amount of money a patient has to pay out of pocket per visit is referred to as what?
Copayment
When an individual first enrolls in an HMO, he or she chooses a ____?
Primary care physician (PCP)
What do most healthcare plans emphasize?
Preventive healthcare
A multispecialty group practice in which all healthcare services are provided within the building(s) owned by the HMO is called a ____?
Staff model
A reimbursement system in which healthcare providers receive a fixed fee for every patient enrolled in the plan, regardless of how many or few services the patient uses, is called a(n) ____ system
Capitation
A managed care system composed of individual healthcare providers who offer healthcare services for HMO and non-HMO patients but maintain their own offices and identities is called what?
Open-panel IPA
A plan that allows patients to use the HMO provider or go outside the plan and pay a higher copayment and deductible is a(n) ____?
Open-end HMO
Most commercial healthcare organizations and MCOs request that they be made aware of and consent to certain procedures and services before their enrollees undergo them, a process called ____?
Precertification
The ____ process can help prevent situations in which the patient may be forced to pay significant out-of-pocket costs
Predetermination of benefis
A procedure required by third-party payers that requires permission before a provider can carry out specific procedures and treatments is a ____?
A “medical right to know”
A type of managed care organization that provides Medicare beneficiaries with alternatives to original Medicare is a(n) ____?
PSO
