100% satisfaction guarantee Immediately available after payment Both online and in PDF No strings attached
logo-home
Revenue Cycle Final UPDATED Exam Questions and CORRECT Answers $7.99   Add to cart

Exam (elaborations)

Revenue Cycle Final UPDATED Exam Questions and CORRECT Answers

 8 views  0 purchase
  • Course
  • Revenue Cycle
  • Institution
  • Revenue Cycle

Revenue Cycle Final UPDATED Exam Questions and CORRECT Answers Which is associated with contracted health care services that are provided to subscribers by two or more physician multispecialty group practices? - Correct Answer- network model HMO Medicare and many states prohibit managed car...

[Show more]

Preview 2 out of 7  pages

  • September 7, 2024
  • 7
  • 2024/2025
  • Exam (elaborations)
  • Questions & answers
  • Revenue Cycle
  • Revenue Cycle
avatar-seller
MGRADES
Revenue Cycle Final UPDATED Exam
Questions and CORRECT Answers
Which is associated with contracted health care services that are provided to subscribers by
two or more physician multispecialty group practices? - Correct Answer- network model
HMO


Medicare and many states prohibit managed care contracts from containing __________,
which prevent providers from discussing all treatment options with patients, whether or not
the plan would provide reimbursement for services. - Correct Answer- gag clauses


A physician-hospital organization (PHO) is owned by hospital(s) and physician groups that
obtain managed care plan contracts. The physicians __________ and provide health care
services to plan members. - Correct Answer- maintain their own practices


Which is a method of controlling health care costs and quality of care by reviewing the
appropriateness and necessity of care provided to patients prior to the administration of care
or after care has been provided? - Correct Answer- utilization management


Which is created when a number of people are grouped for insurance purposes and the cost of
health care coverage is determined by employees' health status, age, sex, and occupation? -
Correct Answer- risk pool


A medical foundation is a nonprofit organization that contracts with and __________ the
clinical and business assets of physician practices. - Correct Answer- acquires


Which is associated with contracted health care services that are delivered to subscribers by
participating physicians who are members of an independent multispecialty group practice? -
Correct Answer- group model HMO


Some managed care plans contract out utilization management services to a utilization review
organization (URO), which is an entity that __________. - Correct Answer- establishes a
utilization management program and performs external utilization review services


To create flexibility in managed care plans, some HMOs and preferred provider organizations
have implemented a(n) __________, under which patients have freedom to use the managed

, care panel of providers or to self-refer to out-of-network providers. - Correct Answer- point-
of-service plan


A group practice without walls (GPWW) establishes a contract that allows physicians to
maintain their own offices and share services, such as __________. - Correct Answer-
appointment scheduling and billing


Which is associated with health care that is provided in an HMO-owned center or satellite
clinic or by physicians who belong to a specially formed medical group that serves the
HMO? - Correct Answer- closed-panel HMO


The primary care provider (PCP) is responsible for __________. - Correct Answer-
supervising and coordinating health care services for enrollees


Which consumer-directed health plan allows participants to enroll in a relatively inexpensive
high-deductible insurance plan and open a tax-deductible savings account to cover current
and future medical expenses? Money deposited (and earnings) is tax-deferred, and money
withdrawn to cover qualified medical expenses is tax-free. Money can be withdrawn for
purposes other than health care expenses after payment of income tax plus a 15 percent
penalty. Unused balances "roll over" from year to year, and if an employee changes jobs, he
or she can continue to use the fund to pay for qualified health care expenses. - Correct
Answer- health savings account


Which program resulted from the Balanced Budget Act of 1997 (BBA) and requires that
quality assurance activities are performed to improve the functioning of Medicare Advantage
(Medicare Part C) organizations? - Correct Answer- quality assessment and performance
improvement (QAPI)


Reviewing the appropriateness and necessity of care provided to patients prior to the
administration of care is called __________ review, and such review after care has been
provided is called __________ review. - Correct Answer- prospective; retrospective


The Health Maintenance Organization (HMO) Assistance Act of 1973 authorized grants and
loans to develop HMOs under private sponsorship. It defines a federally qualified HMO as
being certified to provide health care services to __________ enrollees. - Correct Answer-
Medicare and Medicaid

The benefits of buying summaries with Stuvia:

Guaranteed quality through customer reviews

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

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

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 MGRADES. Stuvia facilitates payment to the seller.

Will I be stuck with a subscription?

No, you only buy these notes for $7.99. You're not tied to anything after your purchase.

Can Stuvia be trusted?

4.6 stars on Google & Trustpilot (+1000 reviews)

80202 documents were sold in the last 30 days

Founded in 2010, the go-to place to buy study notes for 14 years now

Start selling
$7.99
  • (0)
  Add to cart