Managed care plans hmo - Study guides, Class notes & Summaries
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CSPR - Certified Specialist Payment Rep (HFMA) | Questions and Correct Answers | Latest Update 2024/2025
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CSPR - Certified Specialist 
Payment Rep (HFMA) | 
Questions and Correct 
Answers | Latest Update 
2024/2025 
Steps used to control costs of managed care include: - Answer -Bundled 
codes 
Capitation 
Payer and Provider to agree on reasonable payment 
DRG is used to classify - Answer -Inpatient admissions for the purpose 
of reimbursing hospitals for each case in a given category w/a 
negotiated fixed fee, regardless of the actual costs incurred 
Identify the various types of private health plan...
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GBA 1 - Study Guide Questions and Answers Rated A+
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GBA 1 - Study Guide Questions and Answers Rated A+ What was the purpose of the Health Maintenance Organization Act of 1973? The health maintenance organization action of 1973 provided federal initiatives - consisted of federal grants and loans to organizations wishing to investigate the feasibility of "federally qualified HMO" 
How did the passage of the Health Maintenance Organization Act of 1973 affect the growth of HMOs? The government began to withdraw its funding during the Reagan adminis...
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OTP 510 Final Exam Questions and Answers All Correct
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OTP 510 Final Exam Questions and Answers All Correct 
 
The following describes this managed care principle: Panels of health care providers who are contracted with the Managed Care Organization (MCO) provide services, are open or closed, and go through a credentialing process. The primary care physician serves as a gatekeeper to authorize services. - Answer-Limited access to the universe of providers 
 
The following describes this managed care product: This managed care product allows individ...
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Tennessee Health Insurance Exam (100 out of 100) Questions and Answers (Already GRADED A)
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Which of the following types of health insurance covers the cost of providing non-medical custodial care to individuals with cognitive problems? 
A. Disability income insurance 
B. Long-term care insurance 
C. Hospital expense coverage 
D. Medical Expense coverage 
B 
 
 
All of the following are characteristics of a group health insurance plan EXCEPT: 
A. Only group members may be covered. 
B. There is one master contract 
B. Each person has a policy 
D. Benefits are essentially the same for al...
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Tennessee Health Insurance Exam (100% Guaranteed Pass)
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Which of the following types of health insurance covers the cost of providing non-medical custodial care to individuals with cognitive problems? 
A. Disability income insurance 
B. Long-term care insurance 
C. Hospital expense coverage 
D. Medical Expense coverage 
B 
 
 
All of the following are characteristics of a group health insurance plan EXCEPT: 
A. Only group members may be covered. 
B. There is one master contract 
B. Each person has a policy 
D. Benefits are essentially the same for al...
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CSPR - Certified Specialist Payment Rep (HFMA) Exam 2024 With Correct Solutions
- Exam (elaborations) • 20 pages • 2024
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CSPR - Certified Specialist Payment Rep (HFMA) Exam 
2024 With Correct Solutions 
Steps used to control costs of managed care include: - Answer -Bundled codes 
Capitation 
Payer and Provider to agree on reasonable payment 
DRG is used to classify - Answer -Inpatient admissions for the purpose of reimbursing hospitals for each 
case in a given category w/a negotiated fixed fee, regardless of the actual costs incurred 
Identify the various types of private health plan coverage - Answer -HMO 
Conve...
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CPMSM Study Guide Questions and Answers Fully solved 2024
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CPMSM Study Guide Questions and Answers Fully solved 2024 
Non-profit under religious/community control. 
Voluntary/Charitable Hospital 
 
 
 
Non-profit under city, state, county. 
Govt (non-federal) hospital 
 
 
 
 
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Owned/operated by fed gov't, supported by fed funds, e.g., VA. Under direct supervision of Surgeon General. 
Govt (federal) hospital 
 
 
 
Owned by corpor...
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CPCU 556 Personal Financial Planning Review Questions with Answers
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Which insurance plan has a gate keeper physician? Health Maintenance Organization HMO 
 
Which insurance plan has members choose any provider but preferred providers offer decreased medical services costs and lower deductibles? Preferred Provider Organization. 
 
What does a gate keeper physician do? Preapproves specialist visits 
 
Which insurance plan works like an HMO but physicians are only paid based on the services they provide? Exclusive Provider organization 
 
Which has lower premiums E...
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605 Midterm Question with Correct Answers
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Managed Care - CORRECT ANSWER- 1) acts as the insurance company and the 
providers of care. 
2) Employs mechanisms to control (manage) utilization of medical services. 
3) Determines the price at which the services are purchased and how much the 
providers get paid. 
4) Is the most dominant health care delivery system in the United States and available 
to most Americans. This is includes both Health Maintenance Organizations (HMO) and 
Preferred Provider Organizations (PPO). 
5) Employers and g...
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Home Health Aide Exam Review Questions with 100% Complete Solutions, Rated A+
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Providers - Are people or organizations that provide health care, including doctors, nurses, clinics, and agencies. 
 
facilities - are places where care is delivered or administered, including, hospitals, long-term care facilities or nursing homes, and treatment centers. 
 
Payers - people or organizations paying for healthcare services 
 
long term care (LTC) - facilities, also called "nursing homes," "skilled nursing facilities," and "extended care facilities" are for people...
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