Unit 17

Question 1

HMOs consist 2 different types of providers

Answer 1

Preferred Provider Organizations, Point of Service Plans

Question 2

A financial entity providing health care for a subscription

Answer 2

Health Maintenance Organization

Question 3

HMOs are considered what type of payment

Answer 3

Prepaid

Question 4

Preventative measure where the subscriber must see their primary care provider before seeking specialist care

Answer 4

Gatekeeper concept

Question 5

Must seek care within the network

Answer 5

Closed Panel

Question 6

Contractor with health care providers to provide low fees to subscribers

Answer 6

Preferred Provider Organization

Question 7

Not limited to the providers in network

Answer 7

Open Panel

Question 8

Type of HMO that allows subscribers to choose providers from in or out of network

Answer 8

Point of Service Plan (Open panel entities)

Question 9

Measures to make the delivery of healthcare more efficient and cost effective

Answer 9

Managed Care

Question 10

Phases of oversight for insurance covered procedures

Answer 10

Utilization Management, Prospective Review, Concurrent Review, Retrospective Review

Question 11

Oversight that can take place at any point of the process

Answer 11

Utilization Managment

Question 12

Review that takes place before treatment

Answer 12

Prospective Review

Question 13

Review that happens while treatment is taking place

Answer 13

Concurrent Review

Question 14

Review that takes place after treatment

Answer 14

Retrospective Review