Ch 7: True and False

Question 1

T/F: An HMO provides its members with basic healthcare services for a fixed price and for a given period

Answer 1

True

Question 2

T/F: PPOs typically do not require authorization from a PCP for a referral to a specialist

Answer 2

True

Question 3

T/F: PPOs are more tightly controlled by government regulations than HMOs

Answer 3

False

Question 4

T/F: HMOs typically have no deductibles or plan limits

Answer 4

True

Question 5

T/F: The federal government requires that HMOs operate their own facilities, staffed with salaried physicians

Answer 5

False

Question 6

T/F: HMOs are neither accredited nor certified

Answer 6

False

Question 7

T/F: Preauthorization pertains to medical necessity and appropriateness, and guarantees payment

Answer 7

False

Question 8

T/F: Precertification involves collecting information before inpatient admissions or performance of selected ambulatory procedures and services

Answer 8

True

Question 9

T/F: A referral is a request by a healthcare provider for a patient under his or her care to be evaluated or treated or both by another provider

Answer 9

True

Question 10

T/F: In all managed care situations, for the healthcare plan to recognize the referral, it must come from the patient’s designated PCP

Answer 10

False

Question 11

T/F: HIPAA requires that employers offer healthcare coverage

Answer 11

False

Question 12

T/F: Healthcare reform will likely eliminate most managed care arrangements

Answer 12

False