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The intent of managed health care was to
replace fee-for-service plans with affordable, quality care to health care consumers.
Which term best describes those who receive managed health care plan services?
enrollees
The Medical Center received a $100,000 capitation payment in January to cover the health care costs of 150 managed care enrollees. By the following January, $80,000 had been expended to cover services provided. The remaining $20,000 is
retained by the Medical Center as profit.
A nonprofit organization that contracts with and acquires the clinical and business assets of physician practices is called a
medical foundation
A_________is responsible for supervising and coordinating health care services for enrollees
primary care provider
The term that describes requirements created by accreditation organizations is
standards
Which administrative procedure should a medical practice follow when it contracts with a managed care organization (MCO)?
Maintain a separate bookkeeping systems for each capitated plan.
Which is a voluntary process that a health care facility or organization undergoes to demonstrate that it has met standards beyond those required by law?
accreditation
Which define employer contributions and ask employees to be more responsible for health care decisions and cost sharing?
consumer directed health plans
In managed care, the primary care provided (PCP) typically receives a capitation payment and is responsible for managing all if an individual's health care; when the PCP arranges for the individual to receive care from a specialist), is
Sub-Capitation
(PPO) Preferred Provider Organization is a
contracted network of health care providers that provide care to subscribers for a discounted fee.
(IDS) Integrated Delivery System is an
organization of affiliated providers' sites that offer joint health care services to subscribers
(EPO) Exclusive Provider Organization
provides benefits to subscribers who are required to receive services from network providers
(HMO) Health Maintenance Organization
provides comprehensive health care services to voluntarily enrolled members on a prepaid basis
(POS) Point-Of-Service Plan
patients can use the managed care panel of providers (paying discounted health care costs) or self-refer to out-of-network providers,and higher health care cost
Employees and dependents who join a managed care plan are called
enrollees
