US Health Care Chapter 9 Quiz

The medical loss ratio is a subpart of what element of managed Care Financing Insurance Delivery Payment

If you work for a company that delivers health care and processes a lot of discounted fee payments each day, you probably work for a(an) PPO MCO HMO MA

When your HMO forces you to go to a primary care physician before seeing a specialist for a rare disorder, the HMO is engaging in: Process review service cost determination utilization review gatekeeping

How clear is it that recent mergers and acquisitions in the health care landscape have occurred due to the ACA: Certain Somewhat clear Unclear No opinions exists

You are working in health management and are responsible for setting up contracts so that legally separate entities will closely cooperate in delivering a range of services. You most likely work for: Medicare Medicaid an IPA a PHO

Capitation, discounted fees and salaries are three ways in which MCO's pay health care providers: True or False

The Kaiser Foundation Health Plan is an early exemplar of a managed care plan for a small population: True or False

POS plans restrict enrollees to only using in network providers: True or False

If you were one of the first people in your state to have health care provided by an MCO, you probably had, at first at least, an HMO: True or False

In the United States, the main job of cost containment in health care falls to the private sector. True or False

A PPO plan is a hybrid between HMO and POS plans. True or False

CMS uses which of the following as an overall measure of a health plan's quality? HEDIS data A star rating system Self-reporting Accreditation by the NCQA

In which of the following plans can an MCO lose a large number of physicians if a contract is lost? HMO IPA plans POS plans PPO plans HMO group model plans

Research shows that there are issues with access to both primary and specialty care in Medicaid managed care. True or False

What is one aspect in which managed care differs from conventional insurance? Assumption of risk Payment to providers Responsibility for delivery of services Collection of premiums

Most Medicare beneficiaries receive their health care through managed care plans. True or False

In which type of utilization management is a primary care physician's opinion necessary in referring or not referring a patient to a specialist? Retrospective Gatekeeping Concurrent Precertification

A(n) ______ is the purchase of one organization by another; a(n) ______ involves a mutual agreement to unify two or more organizations are brought together. acquisition; merger acquisition; joint venture merger; acquisition joint venture; merger

POS plans restrict enrollees to only using in-network providers. True or False