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16 terms

hairymonkeys

insurance chapter 11 multiple choice

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Ross-Loos

medical group
Americans oldest privately owned, prepaid medical group is the
point of service (POS)
what plan allows members of Kaiser Permanente medical care program to seek medical help from non-Kaiser physicians?
it limits the patients choice of personal physicians
Kaiser permanents medical plan is a closed panel program, which means
health maintenance organization act
a significant contribution to HMO development was the
fee for service
how does an HMO receive payment for the services it physicians provide?
capitation
when an HMO is paid a fixed amount for each patient served without considering the actual number or nature of services provided to each person, this is known as
salary paid by independent group
how are physicians who work for a prepaid group practice model paid?
foundation for medical care
what is the name of an organization of physicians sponsored by a state or local medical association that is concerned with the development and delivery of medical services and the cost of health care
paid salaries by their own independent group
in an independent practice association (IPA), physicians are
preferred provider organization (PPO)
an organization that gives members freedom of choice among physicians and hospitals and provides a higher level of benefits if the providers listed on the plan are used is called a
PPG
a physician-owned business that has the flexibility to deal with all forms of contract medicine and also offers its own plans is a
point of service (POS) plan
a program that offers a combination of HMO-style cost management and PPO-style freedom of choice is a
quality improvement organization
practitioners in an HMO program may come under peer review by a professional group called a
churning
when a physician sees a patient more than is medically necessary, it is called
tertiary care
referral of a patient recommended by one specialist to another specialist is known as
collect the copayment when the patient arrives for the office visit.
what is the correct procedure to collect a copayment on a managed care plan?
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