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CEBS GBA 1: Assignment 4 Exam Questions & Answers (based on the 2013 GBA 1 learning guide)
CEBS GBA 1: Assignment 4 Exam Questions & Answers (based on the 2013 GBA 1 learning guide)
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CEBS GBA 1: Assignment 4 ExamQuestions & Answers (based on the 2013
GBA 1 learning guide)
What is the Health Maintenance Organization Act of 1973? - -provided
federal initiatives to encourage the establishment of HMOs
also known as the health maintenance strategy
offered federal grants and loans to orgs wishing to investigate the feasibility
of federally qualified HMOs
-what caused the growth of HMOs in the 70s and 80s? - -the passage of the
Health Mainenance Organization Act of 1973
-who provided funding to start up HMOs - -the Dept of Health and Human
Services
-Describe the history of PPOs - -this type of organization was sponsored by
insurance companies, TPAs and hospitals for their customers as an
alternative to compete agains HMOs. popular because of cost savings and
more choices in provider listings
-why were PPOs initially unpopular? - -too little emphasis on utilization
control and too focused on discounted fee for service arrangements
-what helped PPOs to grow? - -increased monitoring of utilization,
implementing quality control and surveying member satisfaction
-what is the chief complaint against PPOs? - -they are a weak form of
managed care with rich benefits and are more expensive than HMOs
-what does the term managed care relate to? - -HMOs, fee for service
arrangements, integrated treatment method, a change in the process of
health care delivery
-steerage - -the manged care company's way of directing members to in
network providers. this happens by setting benefit differentials between in
and out of network care between 10% and 30%
-describe standalone UM programs - -1 precertification of inpatient
admissions
2 concurrent review of ongoing confientments for medical necessity
3 discharge planning
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