QUIZ - Chapter 2.1

Which of these has a triple option plan used to exclude members who are sicker than the general population?

Adverse selection

In a managed care plan, the primary care provider (PCP) serves as a

gatekeeper

Which of these is the voluntary process that a facility undergoes to demonstrate that it meets standards beyond those required by law?

Accreditation

Which of these was implemented to create flexibility in managed care plans, which would allow patients to self-refer to out-of-network providers?

Competitive medical plan (CMP)

A provision in a health or managed care plan that requires the policyholder or patient to pay a specified dollar amount to a health care provider for each encounter or medical service received is a

Copayment

The amount for which the patient is financially responsible before an insurance policy provides payment is called the

Deductible

Which of these is a global concept that includes the collection of patient information documented by a number of providers at different facilities regarding one patient?

EHR

Which of these is responsible for reviewing health care provided by managed care organizations?

EQRO

Which regulations govern privacy, security, and electronic transaction standards for health care information?

HIPAA

Which legislation amended the PPACA to implement health care reform initiatives such as increasing tax credits to buy health care insurance, eliminating special deals provided to senators, closing the Medicare "donut bole," and modifying higher education assistance provisions, such as implementing student loan reform?

HCERA

Which legislation included in ARRA amended the Public Health Service Act to establish an Office of the National Coordinator for Health Information Technolozy (ON) within HHS to improve health care quality, safety, and efficiency?

HITECH Act

Which of these is a tax-deferred account used for qualified health care expenses in which unused funds roll over from year to year?

HSA

Which of these includes the provision of preventive services?

Health Care

Which of these is a contract between a policyholder and a third-party payer or government health program to reimburse the polieyholder for all or a portion of the cost of medically necessary treatment or p care provided by a health care professional?

Health insurance

Performance measures developed by NCQA and used to evaluate managed care plans are found in the

Healthcare Effectiveness Data and Information Set (HEDIS).

Which act provided federal grants for modernizing hospitals that had become obsolete and that, in return, were required to provide services to patients unable to pay for care?

Hill-Burton Act

The type of plan that allows patients to seek health care from any provider, and the health plan reimburses the provider according to a fee schedule is a(n)

Indemnity plan

Which of these is purchased by individuals or families who do not have access to group health insurance coverage?

Individual health insurance

Which of these is responsible for the health of a group of enrollees and can be a health plan, hospital, physician group, or health system?

Managed care organization

Which of the following documents health care services provided to a patient and includes patient demographics and treatment history to facilitate continuity of care?

Medical records

Which program provides health care services to Americans over the age of 65?

Medicare

Which of these reviews managed care plans and develops report cards to allow consumers to make informed decisions when selecting a plan?

NCQA

The federal legislation enacted in 1981 that expanded the Medicare and Medicaid programs is called

OBRA

Which of these eased restrictions on preferred provider organizations (PPOs) and allowed subscribers to seek health care from providers outside the PPO?

Preferred Provider Health Care Act of 1985

Medicare is a type of

Public health insurance

Which entity did CMS authorize to perform utilization and quality control review of health care furnished, or to be furnished, to Medicare beneficiaries?

QIOs

Which of these was established by Medicare to ensure the accountability of managed care plans in terms of objective, measurable standards?

QISMC

Which of these is created when the cost of health care coverage is determined by employees' status, age, sex, and occupation?

Risk pool

Which of these is a type of HMO in which health care services are provided to subscribers by physicians employed by the HMO?

Staff model

A health insurance company that provides coverage, such as BlueCross BlueShield, is a

Third-party payer

The physician fee schedule is

a list of predetermined payments for health care services provided to patients

A triple option plan is also called a

cafeteria plan

Which legislation allows employees to continue health care coverage beyond the benefit termination date by paying appropriate premiums?

cobra

A type of plan where employer contributions are defined and employees are asked to be more responsible for health care decisions and cost sharing is a

consumer-directed health plan

Employees and dependents who join a managed care plan are known as

enrollees

Coverage for catastrophic or prolonged illnesses and injuries is known as:

major medical insurance

The concept of combining health care with the financing of services provided is called:

managed care

A nonprofit organization that contracts with and acquires the clinical and business assets of physician practices is called a(n)

medical foundation

A physician or health care facility under contract to a managed care plan is called a(n)

network provider

Prior to scheduling elective surgery, managed care plans sometimes require a

second surgical opinion