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Home  arrow Chapter Review Questions  arrow Chapter 2: Understanding Managed Care: Medical Contracts and Ethics

Chapter 2: Understanding Managed Care: Medical Contracts and Ethics



This activity contains 47 questions.

Question 1.
Coinsurance is paid by the provider.

   
 
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Question 2.
The deductible is the amount the insured must pay for each healthcare encounter, such as an office visit.

   
 
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Question 3.
Under a discounted fee-for-service arrangement, a provider and a payer negotiate the provider's fees.

   
 
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Question 4.
Fee-for-service contracts establish coinsurance payments for patients' charges.

   
 
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Question 5.
HMO members are usually allowed to receive medical services from any provider that they choose without additional cost.

   
 
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Question 6.
Under an indemnity plan, an insurance company agrees to cover the financial losses of a medical practice.

   
 
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Question 7.
A managed care system combines the financing and the delivery of healthcare services.

   
 
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Question 8.
Under a POS option, HMO members can receive services from any provider, but they must pay a greater amount for encounters with non-network providers.

   
 
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Question 9.
A policyholder is a person who buys an insurance plan.

   
 
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Question 10.
Indemnity plans usually require preauthorization for many services.

   
 
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Question 11.
PPO is the abbreviation for plan/provider options.

   
 
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Question 12.
Under a PPO, healthcare providers perform services for plan members at discounted fees.

   
 
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Question 13.
The role of a PCP is to coordinate a patient's overall care.

   
 
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Question 14.
A healthcare provider is an individual, group, or organization that provides medical or other healthcare services.

   
 
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Question 15.
A referral to a specialist by a PCP is usually required under fee-for-service plans.

   
 
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Question 16.
HMOs are usually licensed by local city or town governments.

   
 
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Question 17.
A PPO is the same as an HMO.

   
 
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Question 18.
Fee-for-service plans typically have an annual deductible.

   
 
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Question 19.
The amount of freedom offered in different managed care program (HMO, PPO, EPO) is basically the same.

   
 
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Question 20.
If a patient goes to a network hospital for services, he can always assume all of the physicians are in network as well.

   
 
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Question 21.
If a patient needs to receive emergency care at a hospital, she should notify her insurance company within 1 week of admission.

   
 
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Question 22.
If a provider is listed in the MCO provider directory, it can be assumed they are participating in the network.

   
 
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Question 23.
One incentive for an insured to use a network provider is reduced out-of-pocket costs.

   
 
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Question 24.
PPO plans do not have an annual deductible.

   
 
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Question 25.
A group model HMO contracts with multispecialty physicians' groups to provide physician services to an enrolled group.

   
 
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Question 26.
In the United States, rising medical costs are a result of:

 
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Question 27.
Under a written insurance contract, the policyholder pays a premium and the insurance company provides:

 
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Question 28.
An indemnity plan covers:

 
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Question 29.
Which of the following conditions must be met before payment is made by the insurer?

 
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Question 30.
Under an indemnity plan a patient may use the services of:

 
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Question 31.
Patients who enroll in an HMO may use the services of:

 
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Question 32.
Patients who enroll in a point-of-service type of HMO may use the services of:

 
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Question 33.
In a PPO plan, referrals to specialists are:

 
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Question 34.
Four models of health maintenance organizations are:

 
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Question 35.
In the staff HMO model, physicians are:

 
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Question 36.
When a POS operation is elected under a health maintenance organization, the patient may:

 
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Question 37.
Which of the following is required when a HMO patient is admitted to the hospital?

 
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Question 38.
Health maintenance organizations are regulated:

 
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Question 39.
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Annual physical examinations and routine screening procedures are referred to as

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Question 40.
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A policyholder's includes the spouse and children. 

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Question 41.
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plans are regulated by the Employee Retirement Income Security Act (ERISA). 

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Question 42.
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The is the percentage of each claim that the insured must pay. 

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Question 43.
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In managed care, patients often pay a specified amount called a(n) for an office visit to a provider. 

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Question 44.
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A member of an HMO must get a(n) from the primary care physician before seeing a specialist. 

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Question 45.
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The healthcare delivery system that is like an HMO but does not require the patient to get referrals from a PCP is a(n)

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Question 46.
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The schedule of lists the medical services that are covered by an insurance plan. 

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Question 47.
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The physician who coordinates a patient's care in a health maintenance organization is called the

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