Other Health Plans Flashcards
1
Q
Lisa is in the hospital awaiting surgery. The doctors meet in the morning to discuss the best way to proceed as a routine procedure in their PPO. This is an example of
- retrospective review
- gatekeeping
- concurrent review
- provider credentialing
A
- concurrent review
2
Q
All of the following are examples of medical cost management EXCEPT
- a mandatory 2nd opinion
- ambulatory surgery
- recertification review
- denying claims
A
- denying claims
3
Q
A managed health care system that finances & delivers health care services through contract providers is called
- a major medical association
- an accident & health guaranty association
- a health maintenance organization
- a contract health provider
A
- a contract health provider
