MAB Ch 3 NTQ
1.
What are the benefits of managed care?
2.
What is another name given to enrolles?
3.
To whom are managed care organizations responsible?
4.
Describe the capitation payment system.
5.
List the various roles of the primary care provider.
6.
List the various ways in which quality assurance programs are assess.
7.
Describe HEDIS.
8.
Describe utilization management.
9.
What is the difference between prospective review and retrospective review?
10. What is the difference between preadmission certification and preauthorization?
11. What is the difference between concurrent review and discharge planning?
12. Describe a utilization review organization.
13. What is the purpose of case management?
14. What is the purpose of second surgical opinion (SSO)?
15. What is the purpose of the Gag Clause?
16. Describe physician inceptives.
17. List 6 different managed care models.
18. Describe an Exclusive Provider Organization.
19. Describe the Integrated Delivery System and give 4 examples of this model.
20. Describe Health Maintenance Organization (HMO).
21. Which HMO plans fall under the closed panel model?
22. Which HMO plans fall under the open panel model?
23. Describe the Point of Service (POS) plan. 24. Describe the Preferred Provider Organization (PPO) plan.
25. Describe the Triple Option Plan. What is another name for this plan?
26. Differentiate between adverse selection and risk pool.
27. Describe the Consumer-Directed Health Plan (CDHP).
28. List the different types of Consumer-Directed Health Plan (CDHP).
29. Describe the Customized Sub-Capitation Plan.
30. Describe the Flexible Spending Account.
31. Describe the Health Savings Account.
32. Describe the Health Care Reimbursement Account.
33. Describe the Health Reimbursement Arrangement Account.
34. Who accredits managed care organizations?
35. List the impact that managed care has on physician’s practice.
