Chapter 5 Test

Evidence-based clinical guidelines originate from all of the following sources EXCEPT:

A patient, who was a Medicaid recipient, asked about the types of financial incentives that the MCO used. What should the MCO's administrator do?

Which of the following types of care represent healthcare services delivered by MCOs ?

All of the following actions reflect the roles of PCPs in MCOs except:

True or false? Disease management is closely associated with coordination of care tools of MCOs because efforts of multiple providers must be synchronized in disease management

In which type of HMO are the physicians employees?

All of the following functions are ways that MCOs work toward their goal of quality patient care EXCEPT:

All of the following types of services or populations are common examples of "carve outs" EXCEPT:

Why did Congress pass the Health Maintenance Organization Act of 1973?

Access to mental or behavioral health or medical specialist is through referral. What is the term for the individual who makes the referral?

The patient belongs to a managed care plan. The patient wants to make an appointment with an out-of-network specialist. The plan has approved the appointment as "out-of-network." What should the patient expect?

Which types of MCO allows patients to choose how they will receive services at the time that the patients need the service?

What is the term for an MCO that serves Medicare beneficiaries?

For what reasons do MCOs survey their members for feedback?

All of the following are elements of prescription management EXCEPT:

All of the following services are typically reviewed for medical necessity and utilization EXCEPT:

Which of the following activities do MCOs use as financial incentives to control costs?

All of the following activities are services management tools used in controlling cost EXCEPT:

What is the term that means evaluating for a healthcare service, the appropriateness of its setting and its level of service?

All of the following activities are steps in medical necessity and utilization review EXCEPT: