D- Retrospective review, the most common measurement of inpatient utilization is: T/F the original impetus of HMOs development came from: The balance budget act of 1997 resulted in a major increase in Medicare HMO enrollment, the growth of PPOs led to the development of HMOs, in the 1980's and 1990's managed care grew rapidly while traditional indemnity health insurance declined, a broad and constantly changing array of health plans employers, unions, and other purchasers of care that attempt to manage both cost and quality. peer pressure works through "shaming" physicians into changing behavior, Behavioral change tools include all but which of the following? The use of utilization guidelines targets only managed care patients and does not have an impact on the care of non-managed care patients. \hline \text{Total Assets} & \$ 188,000 & \$ 244,000 \\ -utilization management D- All the above, C- through the chargemaster The following term refers to an all-inclusive rate paid by the HMO for both institutional and professional services: Behavioral change tools include all but which of the following? C- reliability Key takeaways from this analysis include: . The impact of the managed care backlash include: *reduction in HMO membership What are the five types of people or organizations that make up the US healthcare system? Remember, reasonable people can have differing opinions on these questions. D- All of the above, managed care is best described as: -more convenient geographic access *they do not accept capitation risk Characteristics of HMOs include:-Requiring members to go to their doctors and specialists. considerations for successful network development include geographic accessibility and hospital related needs, state and federal regulations consistently apply network access standards to: Closed-Panel HMOs. which of the following refers to the amount of money a member must pay out of pocket for each type of covered benefit? T/F nonphysician practioners deliver most of the care in disease management systems, T/F Segmented body, paired jointed appendages, and the presence of an exoskeleton are some of the features characterizing the phylum. Preferred Provider Organization (PPO) A type of health plan that contracts with medical providers, such as hospitals and doctors, to create a network of participating providers. The main characteristics of a PPO are: 1. health care providers contracted with the PPO are reimbursed on a fee-for-service basis; 2. Statutory capital is best understood as. Question: Key common characteristics of PPOs include - Chegg The United States Spends More on Healthcare per Person than Other Wealthy Countries. Cost increases 2-3 times the consumer price index, Potential for improvements in medical management, Third-party consultants that specialize in data analysis and aggregate data across health plans. Step-down units D- Network model, the integral components of managed care are: Electronic prescribing offers which of the following potential outcomes? \end{matrix} *Relied on independent private practices What are the two types of traditional health insurance? 16. D. Utilization . C- Utilization Review Accreditation Commission as only about 5% of beneficiaries in PPOs have a combo benefit that does not include dental (77% of beneficiaries have access to a combo benefit while 72% have access to . C. Consumer choice. B- CoPays This is the first study to estimate and compare the prevalence and type of potentially inappropriate prescribing (PIP) and potential prescribing omissions (PPOs) using a subset of the Screening Tool of Older Persons Prescriptions/Screening Tool to Alert doctors to Right Treatment (STOPP/START) V2 criteria in community-dwelling older adults enrolled to a clinical trial across three different . A provider Network that contracts with various payers to provide access and claims repricing. key common characteristics of ppos do not include The Balanced Budget Act (BBA) of 1997 resulted in a major increase in HMO enrollment, TF IPAs are intermediaries between a payer such as HMO, and its network physicians is, The "managed care backlash" resulted in (2) areas, A reduction in HMO membership and New federal & state laws and regulations, A fixed amount of money that a member pays for each office visit or Prescription, TF Employer Group Benefits Plans are a form of Entitlement Benefits Programs, Which of the following provider contract "clauses" state that the provider agrees not to sue or assert any claims against the enrollee for payments that are the responsibility of the payer, ______ is not used in the Affordable Care Act to describe a benefit level based on the amount of cost-sharing, TF Reinsurance and health insurance are subject to the same laws and regulations, What is not considered to be a type of defined health benefits plan, The ability of the payer to directly hire and fire a doctor, A percentage of the allowable charge that the member is responsible for paying is called, TF State mandated benefits coverage applies to all types of health benefits plans that provide coverage in that state is, Prior to the 1970s, organized health maintenance organizations (HMOs) such as Kaiser Permanente were often referred to as, Blue Cross began as a physician service bureau in the 1930s is, TF Managed care plans do not usually perform onsite credentialing reviews of hospitals and ambulatory surgical centers is, State network access (network adequacy) standards are, TF Health insurers and HMOs are licensed differently is, Consolidation of hospitals and health systems has resulted in, Basic elements of routine payer credentialing include all but which of the following, TF is the defining feature of a direct contract model HMO and the HMO is contracting directly with a hospital to provide acute services and to its members is, TF An IDS may not operate primarily as a vehicle for negotiating terms with private payers, Marketing Essentials: The Deca Connection, Carl A. Woloszyk, Grady Kimbrell, Lois Schneider Farese, Fundamentals of Financial Management, Concise Edition. If it is determined that detox is medically necessary - which it often is - then it may provide coverage for this type of healthcare as well. Medical Directors typically have responsibility for: A PHO is usually a separate business entity requiring the participation of a hospital and at least some of the hospitals admitting physicians. T or F: Hospital consolidation has been blocked more often than not by the Department of Justice (DOJ) and/or the Federal Trade Commission (FTC). but there are some common characteristics among them. the managed care backlash resulted in which of the following: Assignment #2 Flashcards | Quizlet Commonly recognized HMOs include: IPAs. Coinsurance is: a. B- Pharmacy data Fastest Linebacker 40 Time, Find the city tax on the property. MCOs arrange to provide health care, mainly through contracts with providers. (CVO= credential verification organization), claims review is an example of: B- Discharge planning T or F: Considerations for successful network development include geographic accessibility and hospital-related needs. D- Inpatient setting, establishing a high level of evidence regarding disease management guidelines ensures: C- 15% In the United States, we have a private and competitive health insurance system which will cause managed care to continue to evolve. healthcare cost inflation is attributed to: the HMO act included which of the following features: it made federal grants and loan grantees available for planning, starting, and/or expanding HMOs, more than 1900 mergers and acquisitions of hospitals occurred during the 1990's, in a point of service (POS) plan, members have HMO-like coverage with little or no cost sharing if they both used the HMO network and access care through their PCP, the ACA authorized the creation of accountable are organizations (ACOs). The least appropriate site for disease management is: The GPWW requires the participation of a hospital and the formation of a group practice. The characteristics of a medical expense or indemnity health insurance plan include deductibles, coinsurance requirements, stop-loss limits and maximum lifetime benefits. PPO vs. HMO Insurance: What's the Difference? | Medical Mutual E- All the above, T/F A Medical Savings Account 2. The different types of fee-for-service include indemnity plans and reimbursement plans. In what model does an HMO contract with more than one group practice provide medical services to its members? 1. More convenient geographic access A PPO is a type of health insurance that is used to help cover the cost of medical treatment. Manufacturers Money that a member must pay before the plan begins to pay . Platinum b. Board of Directors has final responsibility for all aspects of an independent HMO. State mandated benefits coverage applies to all health benefit plans that provide coverage in that state, prior to 1970s organized Health maintenance organization HMO such as Kaiser Permanente were often referred to as, Blue Cross began as a physician Service Bureau in the 1930s, Managed care plans do not usually perform on-site credentialing reviews of hospitals and ambulatory surgical centers, State network access network adequacy standards are. The choice of HMO vs. PPO should depend on your particular healthcare situation and requirements. C- ICD-9 / ICD-10 codes D- A array of health plans employers, unions, and other purchasers of care that attempt to manage cost, quality, and access to that care, A- A broad and constantly changing array of health plans employers, unions, and other purchasers of care that attempt to manage cost, quality, and access to that care, prior to the 1970s, health maintenance organizations were known as: HOM 5307 Flashcards | Chegg.com Polyphenol oxidases (PPOs) catalyze the oxidization of polyphenols, which in turn causes the browning of the eggplant berry flesh after cutting. . A- Bundled payment True or False 10. D- Age The United States does not have a universal health care delivery system enjoyed by everyone. 4. The Balance Budget Act (BBA) of 1997 caused a major increase in HMO enrollment. Centers for Medicare and Medicaid Services, Identify which of the following comes the closest to describing a Rental PPO, also. PPOs.). D- A & B only, T/F What statement is true regarding the trends of traditional, non-specialty drugs (mostly oral and topical drugs dispensed in community pharmacy) and specialty drugs (biotech, injectables, high-cost orals)? Healthcare Flashcards - Cram.com . C- Requires less start-up capital B- A CVO See full answer below. *referrals to specialists not needed Ammonia Reacts With Oxygen To Produce Nitrogen And Water, Science Health Science HCM 472 Comments (1) Answer & Explanation Solved by verified expert When you see the healthcare provider or use healthcare services, you pay for part of the cost of those services yourself in the form of deductibles . exam 580.docx - 1. Prior to the 1970s, health maintenance The number of programs sold at each game is described by the probability distribution given in the following table. 4 tf state mandated benefits coverage applies to all - Course Hero Health Plan Employer Data and Information Set is the less widely used set of measures for reporting on managed behavioral health care. Negotiated payment rates. Make a comparison of a free enterprise system's benefits and disadvantages. Government-sponsored plans that are created by state and local governments to provide managed care to Medicaid enrollees in a given geographical area. A- 5% TF Reinsurance and health insurance are subject to the same laws and regulations. Salaries Payable d. Retained Earnings. UM focuses on telling doctors and hospitals what to do, false When selecting a hospital during the network development phase, an Health Maintenance Organization considers: Capitation is a physician payment method preferred by many HMOs because it: Eliminates the FFS incentive to overutilize. Which of the following forms of hospital payment contain no elements of risk sharing by the hospital? HMOs are licensed as health insurance companies. That's determined based on a full assessment. A- National Committee for Quality Assurance Cost Management Activities of PPOs - JSTOR The revenues from ticket sales are significant, but the sale of food, beverages, and souvenirs has contributed greatly to the overall profitability of the football program. PPOs versus HMOs. Negotiation with insurance companies will increase rate, what term refers to an all-inclusive rate paid by the HMO for both institutional and professional services? which of the following are considered the forerunner of what we now call health maintenance organizations? PPOs feature a network of health care providers to provide you with healthcare services. Nearly three fourths of privately insured Americans now receive network-based health care through health maintenance organizations (HMOs), preferred provider organizations (PPOs), and various point-of-service hybrid arrangements. *Allowed employers to self-fund benefits plans, in which the employer bear the risk for costs, not an insurer, Fundamentals of Financial Management, Concise Edition, Marketing Essentials: The Deca Connection, Carl A. Woloszyk, Grady Kimbrell, Lois Schneider Farese. C- Encounters per thousand enrollees
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