Exam (elaborations)
Revenue management | Latest Exam Questions with 100% Correct Answers
- Course
- Institution
Revenue management | Latest Exam Questions with 100% Correct Answers
[Show more]
Content preview
Revenue management | Latest ExamQuestions with 100% Correct Answers
What is an Exclusive Provider Organization? - ✅✅A hybrid between an HMO and a PPO,
EPOs provide one level of benefits. No coverage for going out of network.
Health Maintenance Organization (HMO) - ✅✅Less expensive premiums than PPOs and EPOs
but greater restrictions. Usually provide 100 precent coverage for services provided in
network, but provide no coverage if the person goes out of network, except emergent care.
Describe capitation. - ✅✅Used primarily for HMO members. Generally a flat rate per
member/ per month.
What is a gatekeeper? - ✅✅The enrollee (patient) selects a primary care provider who
becomes the gatekeeper for all services required by the patient. The gatekeeper decides when
and if the patient needs to see a specialist or if the patient should be admitted to the hospital.
Describe the Hold Harmless clause. - ✅✅The HMO may attempt to limit its liability by inserting a
"hold harmless" clause in the physician's contract that shifts most or all of the liability to the
physician. In essence the physician agrees to hold the plan harmless for any liability that arises.
What is a risk withhold? - ✅✅This is the amount withheld from the physician's payment in
a fee-for-service plan.
, What are the 5 challenges with managed care? - ✅✅1. Transitioning to value-based payment.
While most respondents said their organization has at least started shifting its operations
toward value, nearly one out of every five said they have not yet transitioned.
2. Turning data into action or ineffective use of data analytics.
3. Addressing rising pharmaceutical costs.
4. Reacting to healthcare consumerism. Consumers are playing a more active role in selecting
their health plans.
5. Responding to industry consolidation.
Evaluating the Managed care plan is a 4 step process which includes: - ✅✅1. Information
2. Referrals
3. Services
4. Reimbursement
A primary care physician has responsibility for: - ✅✅1. providing initial and primary
medical care to the covered person.
2. Maintaining continuity of covered medical care.
3. Initiating referral to consultants and specialty care physicians.
"_____ __________" means the health care delivery system resulting from a formal
arrangement among Doctor Group, The Company, Physicians, and Health Care Providers. -
✅✅The Company
________ __________ means those processes designed to pursue opportunities to improve
health care, resolve identified problems, and objectively and systematically monitor and
evaluate the quality and appropriateness of health care. - ✅✅Quality Improvement
________ ______________ means that part of the Quality Improvement program involving the
reduction and/or prevention of losses and injuries to covered persons through identification. -
✅✅Risk Management
The benefits of buying summaries with Stuvia:
Guaranteed quality through customer reviews
Stuvia customers have reviewed more than 700,000 summaries. This how you know that you are buying the best documents.
Quick and easy check-out
You can quickly pay through credit card or Stuvia-credit for the summaries. There is no membership needed.
Focus on what matters
Your fellow students write the study notes themselves, which is why the documents are always reliable and up-to-date. This ensures you quickly get to the core!
Frequently asked questions
What do I get when I buy this document?
You get a PDF, available immediately after your purchase. The purchased document is accessible anytime, anywhere and indefinitely through your profile.
Satisfaction guarantee: how does it work?
Our satisfaction guarantee ensures that you always find a study document that suits you well. You fill out a form, and our customer service team takes care of the rest.
Who am I buying these notes from?
Stuvia is a marketplace, so you are not buying this document from us, but from seller Examsplug. Stuvia facilitates payment to the seller.
Will I be stuck with a subscription?
No, you only buy these notes for $13.00. You're not tied to anything after your purchase.
Can Stuvia be trusted?
4.6 stars on Google & Trustpilot (+1000 reviews)
77254 documents were sold in the last 30 days
Founded in 2010, the go-to place to buy study notes for 14 years now