MHO Exam 1 Flashcards | Chegg.com tion oor) placed PPOs in the chart, and the attending staff physicians signed them. A- Through cost-accounting medicaid expansion for ALL families and individuals with incomes of less than 133% of poverty level. which of the following refers to the amount of money a member must pay out of pocket for each type of covered benefit? Limited provider panels b. Bipolar disorder is a mental health condition in which a person shifts between mania, hypomania, and depression intermittently. What is the funding source of each program? Providers A- POS plans in the agent principal problem as understood in the context of moral hazard the agent refers to. D- All the above, advantages of an IPA include: Exam 1 Flashcards - Cram.com Costs of noncatastrophic, recurring outpatient care have risen significantly in the past few decades. Large employers often provide employees with options Orlando and Mary lived together for 14 years in Wichita, Kansas. PPOs.). What patterns do you see? Health Plan Employer Data and Information Set is the less widely used set of measures for reporting on managed behavioral health care. (PPOs) administer the most common types of managed care health insurance plans. Key common characteristics of PPOs include: E. All of the above. 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. To this end, a random sample of 363636 filled bottles is selected from the output of a test filler run. D- All of the above, managed care is best described as: Preferred Provider Organization (PPO) - Glossary | HealthCare.gov Which of the following accounts does a manufacturing company have that a service company does not have? Nearly three fourths of privately insured Americans now receive network-based health care through health maintenance organizations (HMOs), preferred provider organizations (PPOs), and various point-of-service hybrid arrangements. The way it works is that the PPO health plan contracts with . Prior to the 1970s, health maintenance organizations (HMOs) were known as: The majority of prescriptions for behavioral health medications are written by nonpsychiatrists. EPOs share similarities with: PPOs and HMOs. The GPWW requires the participation of a hospital and the formation of a group practice. C- Mission clarity \hline An IPA is an HMO that contracts directly with physicians and hospitals. The conversion of phenolic substrates to o-quinones by PPOs occurs by means of two oxidation steps.The first is the hydroxylation of the ortho-position adjacent to an existing hydroxyl group ("monophenol oxidase" or "monophenolase" activity, also referred to as hydroxylase or cresolase activity).The second is the oxidation of o-dihydroxybenzenes to o . What will the attorney check first? IPAs: An IPA is the physician organization that contracts with HMOs on behalf of its member-physicians. C- 15% More convenient geographic access Reinsurance and health insurance are subject to the same laws and regulations. Saltmine. which of the following is an example of cost sharing a. co payment b. reimbursement c. provider network d. pre-authorization who bears the risk of medicare ? C- Having medical school professors present detailed studies at CME conferences each year the Internal Revenue Service determines what the minimum and maximum deductibles need to be to qualify as a high-deductible health plan. Establishing a high level of evidence regarding disease management guidelines ensures: Value-based insurance designs that assign high-value drugs to Tier 1 for ALL therapeutic categories. A- 5% Briefly Describe Your Duties As A Student, A- Point-of-service programs A change in Behavior caused by being at least partially insulated from the full Economic Consequences of an action. 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 A high-level tyoe of indemnity insurance that applies only to high-cost cases or higher than predicted overall costs. for which benefit is cost sharing not allowed? Advertising Expense c. Cost of Goods Sold What are the three core components of healthcare benefits? Negotiated payment rates (Baylor for teachers in Houston, TX), 1939 B- Stop-loss reinsurance provisions What forms the basis of an appeal? A- I get different results using my own data Most ancillary services are broadly divided into the following two categories. True or False. The choice of HMO vs. PPO should depend on your particular healthcare situation and requirements. A- Cost increases 2-3 times the consumer price index B- New federal and state laws and regulations B- My patients are sicker than other providers' patients B- Is less costly to administer than FFS The Point of Service (POS) managed healthcare system has characteristics of both HMOs and PPOs. The Managed care backlash resulted in which of the following? Consumers seeking access to healthcare Employers All of the above None of the above Question 2.2. growth mindset activities for high school pdf key common characteristics of ppos do not include C- Reduction in prescribing and dispensing errors That's determined based on a full assessment. B- Benefits determinations for appeals the Managed Care backlash resulted in two areas. Set up the null and alternative hypotheses for this hypothesis test. Blue Cross began as a physician service bureau in the 1930s. The same methodology used to pay a hospital for inpatient care is usually also use to pay for outpatient care. A PHO is usually a separate business entity requiring the participation of a hospital and at least some of the hospitals admitting physicians. What specific factors other than diseases commonly affect severity of illness? For each of the following situations with regard to common stock and dividends of a. What Is PPO Insurance. What are the hospital consolidation trends? Trademark}\\ 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 PPO coverage can differ from one plan to the next. nurse on call or medical advice programs are considered demand management strategies, T/F B. 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: a. Generally, wealthier countries such as the United States will spend more on healthcare than countries that are less affluent. Identify the following assets a through i as reported on the balance sheet as intangible assets (IA), natural resources (NR), or other (O). Healthcare Flashcards - Cram.com They apply to coverage for which the insurer or HMO is at risk for medical costs, and which is licensed by the state. Network Coverage. Arthropods are a group of animals forming the phylum Euarthropoda. What are the basic ways to compensate open-panel PCPs? Limited provider panels b. . In other words, consumer products are goods that are bought for consumption by the average consumer. The term "moral hazard" refers to which of the following? A patient has a sudden craving for ice cream induced by receiving a mild electrical stimulation to the hypothalamus. Almost all models of HMOs contract directly with physicians. (TCO A) Key common characteristics of PPOs include _____. 'health plan employer data and information set' is the less widely used set of measures for reporting on managed behavioral healthcare. \text{\_\_\_\_\_\_\_ f. Copyright}\\ The characteristics of a medical expense or indemnity health insurance plan include deductibles, coinsurance requirements, stop-loss limits and maximum lifetime benefits. PPOs versus HMOs. In the 80's and 90's what impact did HMO's have on indemnity plans? True or False 10. B- Health plans with a Medicare Advantage risk contract C- Preferred Provider Organization C- Reducing access Which organization(s) need a Corporate Compliance Officer (CCO)? When you see the healthcare provider or use healthcare services, you pay for part of the cost of those services yourself in the form of deductibles . Regulators. A- Diagnostic and therapeutic Selected provider panels. Electronic prescribing offers which of the following potential outcomes? as only about 5% of beneficiaries in PPOs have a combo benefit that does not include dental (77% of beneficiaries have access to a combo benefit while 72% have access to . -requires less start-up capital 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. A- Costs are predictable When Is 7ds Grand Cross 2nd Anniversary, -utilization management Managed Care - Boston University The implicit interest rate is 12%. PPOs continue to be the most common type of plan . \text{\_\_\_\_\_\_\_ g. Franchise}\\ The bottling company wants to set up a hypothesis test so that the filler will be readjusted if the null hypothesis is rejected. Statutory capital is best understood as. Utilization Review Accreditation Commission, All of the following are alternatives to acute care hospitalization. What is the common benefit design trend in commercial (employer group sponsored) prescription drug benefits? C- Short Stay clinic As the drivers of globalization continue to pressure both the globalization of markets and the globalization of production, we continue to see the impact of greater globalization on worldwide trade patterns. Preferred Provider Organization (PPO): Definition & Overview Which of the following is a method for providing a complete picture of care delivered in all health care settings? (TCO B) The original impetus of HMO development came from which of the following? (creation of western clinic in Tacoma, WA. Ammonia Reacts With Oxygen To Produce Nitrogen And Water, Types of Managed Care Organizations (MCOs) Health Maintenance Organizations (HMOs) Preferred Provider Organizations (PPOs) Exclusive Provider Organizations (EPOs) Point-of-Service Plans (POS) <-- removed online divorce -->. hospital utilization varies by geographical area, T/F 3. He has fallen in love with another woman and plans to marry her. During their cohabitation, they both claimed to be married to one another. HMO. Key common characteristics of PPOs include: (All of the above) Selected provider panels Negotiated payment rates Consumer choice & Utilization management which of the following is not a common form of IDS? PPOs work in the following ways: Cost-sharing: You pay part; the PPO pays part. This may include very specific types . D. Utilization . -overseeing and maintaining final responsibility for the plan. 28 related questions found What is a PPO plan? PPO plans have three defining characteristics. Find common denominators and subtract. Primary care orientation, B- Malpractice history See Answer Question: Key common characteristics of PPOs include Key common characteristics of PPOs include Expert Answer 100% (1 rating) Key common characteristics of PPOs i Copayment is a money that a member must pay before - Course Hero D- Medicare Part D, Approximately 50% of behavioral care spending is associated with what percentage of patients? Key common characteristics of PPOs do not include : a. . B- Insurance companies 2003-2023 Chegg Inc. All rights reserved. The term moral hazard refers to which of the following. PPO (Preferred Provider Organization) PPO plans are among the most common types of health insurance plans. On IDs may not operate primarily as a vehicle for negotiating terms with private payers. Nonphysician practitioners deliver most of the care in disease management systems. You'll get a detailed solution from a subject matter expert that helps you learn core concepts. 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). 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. A PPO offers private health insurance to its members (health benefits and medical coverage) from a network of health care providers contracted by the PPO. B- Pharmacy and radiology MCOs arrange to provide health care, mainly through contracts with providers. HMO plans typically have lower monthly premiums. Centers for Medicare and Medicaid Services, Identify which of the following comes the closest to describing a Rental PPO, also. Medical Directors typically have responsibility for: Nurse-on-call or medical advice programs are considered demand management strategies True or False, It is possible for a specialist to also act as a primary care provider. Members . Total annual out-of-pocket expenses (other than premiums) for covered benefits not to exceed $6,250. 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. C- Independent Physician Association model 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 C- Medical license \end{array} The United States Spends More on Healthcare per Person than Other Wealthy Countries. Scope of services. Add to cart. Many expensive and popular traditional drugs are losing patent protection, and generics are driving a declining cost trend. (POS= point of service), which organization may conduct primary verification of a physician's credentials? C- Prospective review Which of the following is not considered to be a type of defined health benefits plan: State Mandated benefits coverage applies to all types of health benefits plans that provide coverage in that state. Coinsurance is: a. Cost of services What other elements of common-law marriage might be significant in the determination? D- A & B only, why is data analysis an increasingly important health plan function? No-balance-billing clause Force majeure clause Hold-harmless clause 2. D- Minutely scrubbing the data, A- personal meetings between a respected clinician and a doctor or a small group of doctors, T/F Is Mccormick Sloppy Joe Mix Vegan, D- All of the above, which of the following is a method for providing a complete picture of care delivered in all health care settings? State and federal regulations consistently apply network access standards to: Which of the following organizations may conduct primary verification of a physician's credentials? Point of Service plans B- Referred provider organizations HSM 546 W1 DQ2 ManagedCare Plans quantity. acids and proteins). (A. Commonly recognized HMOs include: IPAs. The first part of the research paper will focus on the description of health care systems in the above-mentioned countries while the second part will analyze . test 1 morning tiggle Flashcards | Quizlet a. A growing number of the drugs in the pipeline for FDA approval are injectable products and the specialty drug trend, already at 20%, is expected to increase. 2.1. What type of health plan actually provides health care? HMO, PPO, POS, EPO: What's the Difference? - The Balance A reduction in HMO membership and new federal and state regulations. A- Outlier *new federal and state laws and regulations. D- All the above. A- Enrollees per thousand bed days