If a patient is assigned to a group of physicians and one physician leaves the group practice, who is responsible for the patient now?
a. The rest of the physicians in the group
b. The MCP
c. The IPA
d. A newly chosen PCP
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Q. 2) Since the MCP is responsible for all patient care, the patient cannot ______________in a second insurance program without losing the coverage from the MCP.
a. be seen
b. enroll
c. have allegiance
d. work
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Q. 3) All grievances are logged showing the resolve of the grievance or the date it was referred to the MCP. This is done since:
a. the MCP will request a copy of the log.
b. the government regulations require use of such a log.
c. the policies and procedures of the provider require such a log.
d. None of the above
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Q. 4) If a family is covered under the same MCP plan, and the PCP group is changed for one member, it:
a. will be changed for all family members.
b. can be changed for all family members if desired.
c. will require requests for all family members separately.
d. cannot be changed if just one member wants a change.
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Q. 5) Providers who receive a complaint should first:
a. refer the patient to the IPA.
b. refer the patient to the MCP.
c. attempt to resolve the issue at their level.
d. stop seeing the patient for services.
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Q. 6) How often can a patient transfer from one PCP provider to another?
a. Once a year
b. Twice a year
c. One time only
d. As often desired
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Q. 7) If an MCP notices a pattern of grievances related to the performance of a provider, it may:
a. counsel the provider.
b. terminate the contract with the provider.
c. stop referrals to the provider.
d. turn the provider over to the licensing commission.
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Q. 8) The difference between a complaint and a grievance is:
a. one involves the legal system.
b. one is in writing.
c. one is less important.
d. one must be dealt with immediately.
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Q. 9) The MCP may use withheld capitation amounts to pay for a __________________________at the end of the year.
a. medical management incentive program
b. provider bonus
c. tax incentive
d. quality-of-care program
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Q. 10) The MCP may ___________________ some of the capitation amount each month to protect the HMO from inadequate care or financial practices.
a. change
b. vary
c. withhold
d. increase
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