Help
Options
Didn't know it?
click below
click below
Knew it?
click below
click below
Don't Know
Remaining cards (0)
Know
retry
shuffle
restart
0:00
Embed Code - If you would like this activity on your web page, copy the script below and paste it into your web page.
Normal Size Small Size show me how
Normal Size Small Size show me how
Health Insurance
HI chp 3
| Question | Answer |
|---|---|
| This defines employer contributions and asks employees to be more responsible for healthcare decisions and cost-sharing. | CDHP: Consumer-directed Health Plan |
| List two ways that MCOs impact a practice's administration. | Pages 53 and 54 in textbook |
| Who is responsible for supervising and coordinating healthcare services for enrollees and approves referrals to specialists and inpatient hospital admissions? | Primary care provider |
| This is a private, not-for-profit organization that assesses the quality of managed care plans in the US and releases the data to the public for consideration when selecting a managed care plan. | NCQA: National Committee for Quality Assurance |
| This plan allows participants to enroll in a relatively inexpensive high-deductible insurance plan and a tax-deductible savings account is opened to cover current and future medical expenses. | HSA: Health saving account |
| What is the term when the PCP provides essential healthcare services at the lowest possible cost, avoiding nonessential care, and referring patients to specialists. | Gatekeeper |
| What does the acronym EPO mean? | Exclusive Provider Organization |
| What does the acronym IDS mean? | Integrated Delivery System |
| What does the acronym HMO mean? | Health Maintenance Organization |
| What does the acronym POS mean? | Point-of-service Plan |
| What does the acronym PPO mean? | Preferred Provider Organization |
| What does the acronym PCP mean? | Primary Care Provider |
| This is a review of the appropriateness and necessity of care provided to patients prior to administration of care. | Prospective review |
| This is a review of the appropriateness and necessity of care provided after administration of care. | Retrospective review |
| This is a review for medical necessity of tests and procedures ordered during an inpatient hospitalization. | Concurrent review |
| What reimburses providers for individual healthcare services rendered? | Fee-for-service |
| What is it called when a provider accepts pre-established payments for providing healthcare services to enrollees over a period of time? | Capitation |
| What are payments made directly or indirectly to healthcare providers to encourage them to reduce or limit services? | Physician incentives |
| What is needed prior to scheduling elective surgery? That is, a second physician is asked to evaluate the necessity of surgery. | SSO: Second Surgical Opinion |
| What in a managed-care contract would prevent providers from discussing all treatment options with patients? | Gag clause |
| What is a voluntary process that a healthcare facility or organization undergoes to demonstrate that it has met standards beyond those required by law? | Accreditation |
Created by:
YTIMBC
Popular Insurance sets