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This activity contains 10 questions.
The fixed payment plan offers subscribers (members):
a fixed list of services provided and, therefore, what services are not covered.
a monthly fee for health insurance that starts when you enroll and remains fixed throughout your lifetime.
complete medical care in return for a fixed fee.
complete medical care in return for a fixed reimbursement fee based on the service provided.
Of the following, which one is NOT a type of Managed Care Organization (MCO)?
Exclusive Provider Organization (EPO)
Fee For Service (FFS)
Health Maintenance Organization (HMO)
Preferred Provider Organization (PPO
Which of the following statements is TRUE concerning Medicare and Medicaid?
Both are federal programs.
Both are implemented at the State level.
Both are used only by persons 65 years of age or older.
Both cover all medical services.
Hospitals receive a preset sum for treatment of an illness category, regardless of the actual number of "bed days" of care used by the patient.
A specialty board seeks to:
determine which type of specialty has advanced the most with respect to medical research and quality improvement.
educate physicians with the necessary training in a medical specialty so that they can start treating patients within that specialty.
improve the quality of medical care and treatment by encouraging physicians to further their education and training.
provide licensure for physicians who have met the qualifications and demonstrated proficiency within a medical specialty.
A type of managed care plan is available in which a range of health care services are available to plan members for a predetermined fee. This predetermined fee is known as:
prospective payment system.
PPOs differ from HMOs in that PPOs:
are a fee-for-service program not based on a prepayment or a fixed monthly fee.
members are restricted to certain designated physicians or hospitals.
are part of the managed care network, where HMOs are not.
pay the patient, who reimburses the doctor or hospital; whereas HMOs directly pay the doctor or hospital.
In the 1960s, state legislatures passed laws allowing professionals to incorporate. This type of medical practice is then run by a board of directors.
A new managed care concept that is a combination of HMO and PPO concepts.
Diagnostic Related Groups
Exclusive Provider Organizations
Managed Care Organizations
A type of solo practice where a physician may employ another physician and pay them a salary.
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