key common characteristics of ppos do not includechemical that dissolves human feces in pit toilet
Subacute care Step-down units Outpatient facilities/units Home care Hospice care. Question: Key common characteristics of PPOs include - Chegg A broad and constantly changing array of health plans employers, unions, and other purchasers of care that attempt to manage cost, quality, and access to that care, Health plans with a Medicare Advantage risk contract only, The integral components of managed care are. Risk-bering PPos false Statutory capital is best understood as. 2003-2023 Chegg Inc. All rights reserved. C- Consumers seeking access to health care -entitlement programs Category: HSM 546HSM 546 These are challenging issues, but it is vital that we. Plans that restrict your choices usually cost you less. What specific factors other than diseases commonly affect severity of illness? B- Episodes of care What Is a PPO and How Does It Work? - Verywell Health Costs of noncatastrophic, recurring outpatient care have risen significantly in the past few decades. A- National Committee for Quality Assurance Benefits determinations for appeals True. You can also expect to pay less out of pocket. A- Analytics (also, board certification), what does an HMO consider when selecting a hospital during the network development? HOM 5307 Exam 1 Set 2 Flashcards | Quizlet 13. All managed care organizations supervise the financing of medical care delivered to members . 16. considerations for successful network development include geographic accessibility and hospital related needs, state and federal regulations consistently apply network access standards to: PPOs versus HMOs. What other elements of common-law marriage might be significant in the determination? C- Reducing access Medicare and Medicaid HMOs. Copayment: A fixed amount of money that a member pays for each office visit or prescription individual health insurance is less expensive for the same level of coverage than are group health benefit plans, false T or F: In the medical management area, committees serve to diffuse some elements of responsibility and allow important input from the field into procedure and policy or even into case-specific interpretation of existing policy. Identify the following assets a through i as reported on the balance sheet as intangible assets (IA), natural resources (NR), or other (O). A PHO is usually a separate business entity requiring the participation of a hospital and at least some of the hospital's admitting physicians true PHO = physician hospital organization T/F hospitals purchased physician practices and employed physicians in the 1990s but will no longer do so false T/F _______a. Considerations for successful network development include geographic accessibility and hospital-related needs. The first important characteristic of PPO is that it allows its plan members to visit any doctor or hospital without referrals from the members' Primary Care Physicians (PCP). b. Arthropods are a group of animals forming the phylum Euarthropoda. Centers for Medicare and Medicaid Services, Identify which of the following comes the closest to describing a Rental PPO, also. a specialist can also act as a primary care provider, T/F Find common denominators and subtract. (b) Would you think that further variance reduction efforts would be a good idea? HIPDB = healthcare integrity and protection data bank, T/F T or F: Managed care plans perform onsite reviews of hospitals and ambulatory surgical centers. the majority of prescriptions for behavioral health medications are written by non-psychiatrists, T/F Exclusive Provider Organization (EPO): A managed care plan where services are covered only if you use doctors, specialists, or hospitals in the plan's network (except in an emergency . Instead, multiple subsystems have developed, either through market forces or the need to take care of certain population seg-ments. E- A, C and D, T/F advantages of an IPA include: A- Broader physician choice for members B- More convenient geographic access For covered workers in PPOs, the most common plan type, the average deductible for single coverage in small firms is considerably higher than the average deductible in large firms ($1,972 vs. $976) . outbound calls to physicians are an important aspect to most DM programs, T/F These include provider networks, provider oversight, prescription drug tiers, and more. Cash inflow and cash outflow should be reported separately in the investing activities section. Managed Care Point-of-Service (POS) Plans. fee for service physicians are financially rewarded for good disease management in most environments, T/F The enrollees may go outside the network, but would incur larger costs in the form of higher deductibles, higher coinsurance rates, or non- Managed Care and HMOs. A- Concurrent review What are the hospital consolidation trends? A- The Department of Defense TRICOR program a fixed amount of money that a member pays for each office visit or prescription. Exam 1 Flashcards - Cram.com HMOs are licensed as health insurance companies. A PPO is an organization that contracts with health care providers who agree to accept discounts from their usual and customary fees and comply with utilization review policies in return for the patient flow they expect from the PPO. Key common characteristics of PPOs do not include: TF The GPWW requires the participation of a hospital and the formation of a group practice, Commonly recognized types of HMOS include all but, Most ancillary services are broadly divided into the following two categories, TF A Flexible Savings Account (FSA) is the same as a Medical Savings Account (MSA). Fee-for-service payment is the most common method used by HMOs to pay specialists. C- Mission clarity C- DRGs State and federal regulations consistently apply network access standards to: Which of the following organizations may conduct primary verification of a physician's credentials? Healthcare Flashcards - Cram.com A- Group model The term "managed care" is used to describe a type of health care focused on helping to reduce costs, while keeping quality of care high. If the university decided to print 2,5002,5002,500 programs for each game, what would the average profits be for the 10 games that were simulated? A- Diagnostic and therapeutic Identify examples of the types of defined health benefits plan: *individual health insurance -individual coverage An IPA is an HMO that contracts directly with physicians and hospitals. Hospital consolidation has been blocked more often than not by the Department of Justice (DOJ) and/or Federal Trade Commission (FTC), T/F 1. the HIPDB is a national health care fraud and abuse data collection program for the reporting and disclosure of certain final adverse action taken against health care providers, suppliers, or practitioners, true Which of the following accounts does a manufacturing company have that a service company does not have? the affordable care act requires US citizens to: -broader physician choice for members T or F: Board of Directors has final responsibility for all aspects of an independent HMO. Managed Care - Boston University \text{\_\_\_\_\_\_\_ d. Gold mine}\\ *referrals to specialists not needed Health insurers in hmos are licensed differently. B- Requiring inadequate physicians to write out, in detail, what they should be doing Discussion of the major subsystems follows. _________is not considered to be a type of defined health benefits plan. A- Utilization management Medical Directors typically have responsibility for: Utilization management HSM 546 W1 DQ2 ManagedCare Plans quantity. Employers are usually able to obtain more favorable pricing than individuals can B- Primary care orientation _______a. EPOs share similarities with: PPOs and HMOs. a. In markets with high levels of managed care penetration, hospitals are usually paid using a sliding scale discount on charges method. True or False 10. Preferred Provider Organization - an overview | ScienceDirect Topics What is the meaning of the phrase "based on prior restraint on freedom of speech " in this case? (POS= point of service), which organization may conduct primary verification of a physician's credentials? D- All the above, T/F Key common characteristics of PPOs include: Selected provider panels Negotiated payment rates Consumer choice Utilization management . Medical Directors typically have responsibility for: You pay less if you use providers that belong to the plan's network. C- Requires less start-up capital Lakorn Galaxy Roy Leh Marnya, C- Every organization that provides health care, A and B (hospitals and health plans with a medicare advantage risk contract), 2.7 Suffixes for the Nervous System 2.8 Suffi, HOM 5307 Managing Healthcare Organizations; F, Marketing Essentials: The Deca Connection, Carl A. Woloszyk, Grady Kimbrell, Lois Schneider Farese, Fundamentals of Financial Management, Concise Edition. Is Mccormick Sloppy Joe Mix Vegan, a broad and constantly changing array of health plans employers, unions, and other purchasers of care that attempt to manage both cost and quality the Health and Insurance Portability and Accountability Act limos the ability of health plans to: -deny insurance based on health status -exclude coverage of preexisting conditions To apply for AIM, call 1-800-433-2611. In what model does an HMO contract with more than one group practice provide medical services to its members? Key common characteristics of PPOs include: selected provider panels negotiated payment rates consumer choice utilization management all of the above selected provider panels & negotiated payment rates & utilization management 10. Part B (Medical Insurance) covers most medically necessary doctors' services, preventive care, durable medical equipment, hospital outpatient services, laboratory tests, x-rays, mental health care, and some home health and ambulance services. A- Fee-for-service including withhold provisions the typical practicing physician has a good understanding of what is happening with his or her patient in between office visits, The least appropriate site for disease management is: (**he might change the date to make it true), false Identify, which of the following comes the closest to describing a rental PPO also called a leased Network. Step-down units Concepts of Managed Care MIDTERM HA95.docx, Test Bank Exam 1 Principles of Managed Care 012820.docx, 2 points Key common characteristics of PPOs do NOT include: Limited provider panels O Discounted payment rates Consumer choice O Utilization management Benefits limited to in-network care. It paid cash dividends of7,500ofcommonstockandpaidnodividends.b.Thecompanyissuednocommonstock.Itpaidcashdividendsof 13,000. The defining feature of a direct contract model is the HMO contracting directly with a hospital to provide acute services to its members. The term moral hazard refers to which of the following. In other words, consumer products are goods that are bought for consumption by the average consumer. Key Takeaways. Qualified Health Plans (these are Obamacare plans that can be purchased with a subsidy) Catastrophic Plans (primarily available to people under age 30) Government-sponsored health insurance coverage (Medicare, Medicaid, etc.) General oversight of the profitability or reserve status rests with the board, as does oversight and approval of significant fiscal events and quality management. Assignment #2 Flashcards | Quizlet The cost-sharing provisions for outpatient surgery are similar to those for hospital admissions, as most workers have coinsurance or copayments. The amount of resources a country allocates for healthcare varies based on its political, economic, and social characteristics. Both overfilling and underfilling bottles are undesirable: Underfilling leads to customer complaints and overfilling costs the company considerable money. The HMO Act of 1973 did contributed to the growth of managed care. State network access (network adequacy) standards are: A The same for physicians and hospitals B Based on drive times to any contracted provider Apply equally to HMOS, POS plans, and PPOs D Based on open practices Coinsurance is: A not a type of cost-sharing Money that a member must pay before the plan begins to pay A fixed amount of money that a The impact of the managed care backlash include: *reduction in HMO membership B- Pharmacy and radiology The most common measurement of inpatient utilization is: Managed prescription drug programs must be flexible and customize pharmacy benefit designs to accommodate diverse financial and benefit richness desires of their customers, The typical practicing physician has a good understanding of what is happening with his or her patient between office visits, Blue Cross began as a physician service bureau in the 1930s, Fee-for-service physicians are financially rewarded for good disease management in most environments, Select the one technique for controlling drug benefits costs that MOST health plans and PBMs DO NOT routinely use. Which of the following is a typical complaint providers have about health plan provider profiling? D- All the above, In January 2006, what large federal prescription drug program was implemented that offered pharmacy benefits to more than 40 million people at that time and is expected to increase by 30% throughout the next decade? Point-of-service (POS) plans are a type of Medicare managed care plan that acts as a hybrid HMO and PPO policy. Pre-certification that includes the authorized coverage length of stay in markets with high levels of managed care penetration, hospitals are usually paid using a sliding scale discount on charges method, what forms of hospital payment contain no elements of risk sharing by the hospital? in the agent principal problem as understood in the context of moral hazard the agent refers to. Outpatient facilities/units A- Outreach clinic A- Broader physician choice for members *ALL OF THE ABOVE*. C- Through the chargemaster Point of Service (POS): A POS managed care plan is offered an option within many HMO plans. most of the care in disease management systems is delivered in inpatient settings since the acuity is much greater, T/F Who has final responsibility for all aspects of an independent HMO? PPOs have lost some of their popularity in recent years as health plans reduce the size of their provider networks and increasingly switch to EPOs and HMOs in an effort to control costs. Which organization(s) accredit managed behavioral health care companies? -consumer choice A PPO is a type of health insurance that is used to help cover the cost of medical treatment. Advertising Expense c. Cost of Goods Sold True False False 7. basic elements of routine pair credentialing include all but one of the following. Members . However, citizens in nations with more benefits pay higher taxes to finance these "safety net" programs that provide support for those in need. C- Utilization Review Accreditation Commission Which organizations may not conduct primary verification of a physicians credentials ? acids and proteins). Solved 1. Which of the following is not considered to be a - Chegg What are the two types of traditional health insurance? physician behavior begins with a mindset established in med school, academic detailing refers to: b. UM focuses on telling doctors and hospitals what to do, false PPOs generally offer a wider choice of providers than HMOs. Scope of services. What are the five types of people or organizations that make up the US healthcare system? Key common characteristics of PPOs include: Prepayment for services on a fixed, per member per month basis. B- Insurance companies PSOs, created by the BBA of 1997, proved to be very popular and successful. In order to verify that the filler is set up correctly, the company wishes to see whether the mean bottle fill, \mu, is close to the target fill of 161616 ounces. Salaries Payable d. Retained Earnings. *they do not accept capitation risk \text{\_\_\_\_\_\_\_ f. Copyright}\\ TF Health insurers and Blue Cross Blue Shield plans can act as third party administrators(TPAs).True or False 10. D- none of the above, common sources of information that trigger DM include: The Balance Budget Act (BBA) of 1997 caused a major increase in HMO enrollment. Hospital utilization varies by geographical area. Health economic data, including a growing number of head-to-head clinical trials, Member copayment coupons to offset copayment. Main Characteristics of Managed Care MCOs manage financing, insurance, delivery, and payment for providing health care: Premiums are usually negotiated between MCOs and employers. Key common characteristics of PPOs do not include: Benefits limited to in-network care TF The GPWW requires the participation of a hospital and the formation of a group practice False Commonly recognized types of HMOS include all but PHOs Most ancillary services are broadly divided into the following two categories Diagnostic and Therapeutic Managed Care Managed careis a system of health care delivery that (1) seeks to PPOs came into existence because the oversupply of hospital beds and . HSM 546 W1 DQ2 ManagedCare Plans - originalassignment.com Payment to a facility for outpatient procedures may be increased on a case-by-case basis through which of the following? *Relied on independent private practices Medicaid Relating to the unique characteristics of PPOs listed above, data are not generally available on (i) style of practice characteristics for a restricted panel of providers or (ii) the administrative operations that lead to a re- COST MANAGEMENT ACTIVITIES OF PPOS 221 stricted set of covered benefits. POS plans offer several benefits found in both HMO and PPO plans. B- Reduction in drug interactions and resulting serious adverse effects Now they are living apart. C- Capitation What Is PPO Insurance. Service plans What was the major consolidation trend in the 1990s? *group is cheaper than individual*, the defining feature of a direct contract model is the HMO contracting directly with a hospital to provide acute services to its members. There are four main types of managed health care plans: health maintenance organization (HMO), preferred provider organization (PPO), point of service (POS), and exclusive provider organization (EPO). c. A percentage of the allowable charge that the member is responsible for paying. Lower monthly premiums, lower out-of-pocket costs, which may or may not include a deductible. Try it. State laws may require health plans to cover the costs of certain defined types of care and services as well as services provided by certain types of providers Key common characteristics of PPOs include: a, b and d only (Selected provider panels, Negotiated payment rates, Utilization management). provider as with an HMO, but you also get to visit out-of-network providers as with a PPO. 2.1. How are outlier cases determined by a hospital? PPO vs. HMO Insurance: What's the Difference? | Medical Mutual PPOs differ from HMOs because they do not accept capitation risk and enrollees that are willing to pay higher cost sharing may access providers that are not in the contracted network, T/F All three of these methods are used to manage utilization during the course of a hospitalization: C- State Medicaid programs Need a Personal Loan? PPOs allow participants to venture out of the provider network at their discretion and do not require a referral from a primary care physician. 28 related questions found What is a PPO plan? You can use doctors, hospitals, and providers outside of the network for an additional cost. PPOs versus HMOs. In response, health insurers introduced "managed care," a series of options that manage the cost of healthcare and, thus, help employers keep premiums under control. C- Carve-outs \text{\_\_\_\_\_\_\_ c. Leasehold}\\ D- Network model, the integral components of managed care are: key common characteristics of ppos do not include benefits limited to in network care The GPWW requires the participation of a hospital and the formation of a group practice. HMOs are licensed as health insurance companies. What is a PPO? B- Negotiated payment rates D- All the above, payment to a facility for outpatient procedures may be increased on a case-by-case basis through: Briefly Describe Your Duties As A Student, B- 10% \end{array} Increasing copayment amounts, especially for Tier 2 preferred brand drugs and Tier 3 non-preferred brand drugs. State and federal regulations consistently apply network access standards to: Which of the following organizations may conduct primary verification of a physicians credentials? PPOs differ from HMOs because they do not accept capitation risk and enrollees who are willing to pay higher cost sharing may access providers that are not in the contracted network. C- Reduction in prescribing and dispensing errors Board Exams. cost of non catastrophic, recurring outpatient care has risen significantly in the past few decades, T/F Characteristics of group health insurance include: true group plan-one in which all employees must be accepted for coverage regardless of physical condition. Compare and contrast the benefits of Medicare and Medicaid. Third-party payers are those insurance carriers, including public, private, managed care, and preferred provider networks that reimburse fully or partially the cost of healthcare provider services . 1. . The Court held that the law was a prior restraint on freedom of speech and of the press under the 1st Amendment. C- The quality and cost measures used are not accurate enough Money that a member must pay before the plan begins to pay. Payment: If the primary care doctor makes a referral outside of the network of providers, the plan pays all or most of the bill. They apply to coverage for which the insurer or HMO is at risk for medical costs, and which is licensed by the state. d. Cash inflow and cash outflow should be reported separately in the financing activities section. *Allowed employers to self-fund benefits plans, in which the employer bear the risk for costs, not an insurer, Fundamentals of Financial Management, Concise Edition, Marketing Essentials: The Deca Connection, Carl A. Woloszyk, Grady Kimbrell, Lois Schneider Farese. \text{\_\_\_\_\_\_\_ g. Franchise}\\ a. (Points : 5) Providers seeking patient revenues Consumers seeking access to healthcare Employers All of the above None of the above Question 2.2. *medicare What technique is used by many pharmaceutical companies with health plans and PBMs to increase formulary access and utilization of specific products? D- All the above, C- through the chargemaster What are the key components of managed care? Apply Concepts In the case Burs tyn, Inc. v. Wilson , 1952, the Supreme Court voided a New York law that allowed censors to forbid the commercial showing of a motion picture that it had decided was "sacrilegious." C- Laboratory and therapeutic nurse on call or medical advice programs are considered demand management strategies, T/F False. C- Encounters per thousand enrollees All three methods used to manage utilization during the course of a hospitalization. Prior to the 1970s, health maintenance organizations (HMOs) were known as: The majority of prescriptions for behavioral health medications are written by nonpsychiatrists. Ipas are intermediaries Between appear such as an HMO and its Network Physicians. A- A reduction in HMO membership B- Statistical significance C- Reduced administrative costs, A- A reduction in HMO membership What is the best managed care organization? Who has final responsibility for all aspects of an independent HMO? During their cohabitation, they both claimed to be married to one another. D- Performance based compensation system, C- prepayment for services on a fixed, per member per month basis, in what model does an HMO contract with more than one group practice to provide medical services to its members? D- Age Selected provider panels. HSA4109- CHP 1, 2, & 3 Flashcards | Quizlet the major impetus behind the passage of the Affordable Care Act was: rising costs leading to more uninsured individuals. If the sample results cast a substantial amount of doubt on|the hypothesis that the mean bottle fill is the desired 161616 ounces, then the filler's initial setup will be readjusted. D- Straight DRGs, capitation is a physician payment method preferred by many HMOs because: A Medical Savings Account 2. Advantages of IPA do not include. nonphysician practioners deliver most of the care in disease management systems, T/F Managed care plans perform onsite reviews of hospitals and ambulatory surgical centers. Exam 1 Flashcards | Quizlet The limits in 2011 for families are: A deductible of $2,500 or more. Which organization(s) need a Corporate Compliance Officer (CCO)? TotalAssetsTotalLiabilitiesMay31,2016$188,000122,000June30,2016$244,00088,000. Coinsurance: A percentage of the total of what the plan covers that the member is responsible for paying behavioral healthcare providers are paid under methodologies similar to those applied to medical/surgical care providers, T/F Approximately What percentage of behavioral care spending is associated with what percentage of patients? . electronic clinical support systems are important in disease management, T/F A Health Maintenance Organization (HMO . the Managed Care backlash resulted in two areas. (TCO A) Key common characteristics of PPOs include _____. Utilization management, A broad and constantly changing array of health plans employers, unions, and other purchasers of care that attempt to manage both cost and quality. The Crown Bottling Company has just installed a new bottling process that will fill 161616-ounce bottles of the popular Crown Classic Cola soft drink. Common sources of information that trigger DM include: Health care cost inflation has remained consistent since 1995. This has a negative impact on fruit quality for both industrial transformation and fresh consumption. That's determined based on a full assessment. B. Providers Premiums may be similar to or slightly higher than HMOs, and out-of-pocket costs are generally higher and more complicated than those for HMOs. the original impetus of HMOs development came from: The balance budget act of 1997 resulted in a major increase in Medicare HMO enrollment, the growth of PPOs led to the development of HMOs, in the 1980's and 1990's managed care grew rapidly while traditional indemnity health insurance declined, a broad and constantly changing array of health plans employers, unions, and other purchasers of care that attempt to manage both cost and quality. Board of Directors has final responsibility for all aspects of an independent HMO. D- Sliding scale FFS, what are the basic ways to compensate open-panel PCPs? Any programs that are not sold are donated to a recycling center and do not produce any revenue. False. Coinsurance is: a. What is your view of government safety net programs ? The use of utilization guidelines targets only managed care patients and does not have an impact on the care of non-managed care patients. Non-risk-bearing PPOs PPO plans have three defining characteristics. The bottling company wants to set up a hypothesis test so that the filler will be readjusted if the null hypothesis is rejected. The Balanced Budget Act (BBA) of 1997 resulted in a major increase in HMO enrollment, TF IPAs are intermediaries between a payer such as HMO, and its network physicians is, The "managed care backlash" resulted in (2) areas, A reduction in HMO membership and New federal & state laws and regulations, A fixed amount of money that a member pays for each office visit or Prescription, TF Employer Group Benefits Plans are a form of Entitlement Benefits Programs, Which of the following provider contract "clauses" state that the provider agrees not to sue or assert any claims against the enrollee for payments that are the responsibility of the payer, ______ is not used in the Affordable Care Act to describe a benefit level based on the amount of cost-sharing, TF Reinsurance and health insurance are subject to the same laws and regulations, What is not considered to be a type of defined health benefits plan, The ability of the payer to directly hire and fire a doctor, A percentage of the allowable charge that the member is responsible for paying is called, TF State mandated benefits coverage applies to all types of health benefits plans that provide coverage in that state is, Prior to the 1970s, organized health maintenance organizations (HMOs) such as Kaiser Permanente were often referred to as, Blue Cross began as a physician service bureau in the 1930s is, TF Managed care plans do not usually perform onsite credentialing reviews of hospitals and ambulatory surgical centers is, State network access (network adequacy) standards are, TF Health insurers and HMOs are licensed differently is, Consolidation of hospitals and health systems has resulted in, Basic elements of routine payer credentialing include all but which of the following, TF is the defining feature of a direct contract model HMO and the HMO is contracting directly with a hospital to provide acute services and to its members is, TF An IDS may not operate primarily as a vehicle for negotiating terms with private payers, Marketing Essentials: The Deca Connection, Carl A. Woloszyk, Grady Kimbrell, Lois Schneider Farese, Fundamentals of Financial Management, Concise Edition.
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