key common characteristics of PPOs include: -selected provider panels HIPDB = healthcare integrity and protection data bank, T/F D- All the above, advantages of an IPA include: In what model does an HMO contract with more than one group practice provide medical services to its members? The same methodology used to pay a hospital for inpatient care is usually also use to pay for outpatient care. These are challenging issues, but it is vital that we. D. Utilization . the most effective way to induce behavior changes in physician is through continuing medical education, T/F Advertising Expense c. Cost of Goods Sold D- All of the above, managed care is best described as: D- Bed days per thousand enrollees, T/F D- A and B, how are outlier cases determined by a hospital? Write your answers in simplest terms. Costs of noncatastrophic, recurring outpatient care have risen significantly in the past few decades. A- Outreach clinic The characteristics of a medical expense or indemnity health insurance plan include deductibles, coinsurance requirements, stop-loss limits and maximum lifetime benefits. A- Cost increases 2-3 times the consumer price index A- A reduction in HMO membership Compared to PPOs, HMOs cost less. MHO Exam 1 Flashcards | Chegg.com Behavioral health care providers are paid under methodologies similar to those applied to medical/surgical care providers. MCOs function like an insurance company and assume risk. Health care professionals that are not a part of the PPO are considered out-of-network. B- Statistical significance _______a. Course Hero is not sponsored or endorsed by any college or university. -utilization management Exclusive Provider Organization (EPO): A managed care plan where services are covered only if you use doctors, specialists, or hospitals in the plan's network (except in an emergency . Which of the following forms of hospital payment contain no elements of risk sharing by the hospital? 1. . C- Prepaid practices \text{\_\_\_\_\_\_\_ f. Copyright}\\ As you progress in your major you probablyread about, this week you will locate ONE newspaper/magazine article via the Internet about a recent incident in your major course of study. The survey includes questions on the cost of health insurance, health benefit offer rates, coverage, eligibility, plan type enrollment, premium contributions, employee cost sharing . The term "moral hazard" refers to which of the following? What are the commonly recognized types of HMOs? *Federal legislation that superseded state laws that restricted the development of HMS. A- Improvement in physician drug formulary prescribing conformance A property has an assessed value of $72,000\$ 72,000$72,000. C- The quality and cost measures used are not accurate enough PPO plans have three defining characteristics. All three of these methods are used to manage utilization during the course of a hospitalization: 3. If the sample results cast a substantial amount of doubt on|the hypothesis that the mean bottle fill is the desired 161616 ounces, then the filler's initial setup will be readjusted. HSM 546 W1 DQ2 ManagedCare Plans - originalassignment.com A- Concurrent review Managed care plans perform onsite reviews of hospitals and ambulatory surgical centers. (A. Health plans with a Medicare Advantage risk contract. New federal and state laws and regulations. 7566648693. Increasing copayment amounts, especially for Tier 2 preferred brand drugs and Tier 3 non-preferred brand drugs. the Managed Care backlash resulted in two areas. behavioral healthcare providers are paid under methodologies similar to those applied to medical/surgical care providers, T/F A- I get different results using my own data The most common measurement of inpatient utilization is: Managed prescription drug programs must be flexible and customize pharmacy benefit designs to accommodate diverse financial and benefit richness desires of their customers, The typical practicing physician has a good understanding of what is happening with his or her patient between office visits, Blue Cross began as a physician service bureau in the 1930s, Fee-for-service physicians are financially rewarded for good disease management in most environments, Select the one technique for controlling drug benefits costs that MOST health plans and PBMs DO NOT routinely use. which of the following are considered the forerunner of what we now call health maintenance organizations? Which of the following is a method for providing a complete picture of care delivered in all health care settings? T or F: In the medical management area, committees serve to diffuse some elements of responsibility and allow important input from the field into procedure and policy or even into case-specific interpretation of existing policy. TotalAssetsTotalLiabilitiesMay31,2016$188,000122,000June30,2016$244,00088,000. These providers make up the plan's network. B- Public Health Service and Indian Health Service A- 5% Premiums may be similar to or slightly higher than HMOs, and out-of-pocket costs are generally higher and more complicated than those for HMOs. The defining feature of a direct contract model is the HMO contracting directly with a hospital to provide acute services to its members.