Other Health Plans Flashcards

1
Q

Lisa is in the hospital awaiting surgery. The doctors meet in the morning to discuss the best way to proceed as a routine procedure in their PPO. This is an example of

  • retrospective review
  • gatekeeping
  • concurrent review
  • provider credentialing
A
  • concurrent review
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2
Q

All of the following are examples of medical cost management EXCEPT

  • a mandatory 2nd opinion
  • ambulatory surgery
  • recertification review
  • denying claims
A
  • denying claims
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3
Q

A managed health care system that finances & delivers health care services through contract providers is called

  • a major medical association
  • an accident & health guaranty association
  • a health maintenance organization
  • a contract health provider
A
  • a contract health provider
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