Hsa4109 - Study guides, Class notes & Summaries

The term "Health Maintenance Organization" was coined by whom? Dr. Paul Ellwood (p. 125) What are the three key elements of classical quality management? structure, process, outcome (p.149) Utilization management seeks to reduce practice variation while promoting good outcomes and which of the following?: a. Maintaining costs b. Deducing access c. All of the above d. Increasing patients

Once a claim is captured, the enrollment status is checked and the member is covered, what is the next step for processing the claim?determining what to pay Plans can receive bonus payments for high star quality ratings. The bonus payments can be used to:(All) Reduce cost sharing Provide additional benefits Reduce enrollee premiums Dual Eligible Special Needs Plans enroll individuals who are "dual eligible." Who are the "dual eligible"?Individuals who are eligible for Medicare and...

Which of the following is not a type of managed Medicaid plan? PFFS Dual Eligible Special Needs Plans enroll only which type of individual? Individuals who are eligible for medicare and medicaid Plans can receive bonus payments for high star quality ratings. The bonus payments can be used to: All of the aboveProvide additional benefits, reduce cost sharing, reduce enrollee payments Which of the following is not a measure in the Medicare Quality Bonus Program (QBP; i.e. the "Stars" p...