What is the purpose of diagnostic related groups?
A) To set classifications for the types of services providers may offer to plan members
B) To determine payment rates for health care services based on patient diagnoses
C) To establish codes used in health care billing based on patient tests and diagnoses
D) To legislate the terms under which Medicare will pay for health care services
Which type of managed care plan involves the coordination of care by a primary care physician and is a hybrid of HMO and PPO structures?
A) Health maintenance organization
B) Preferred provider organization
C) Point-of-service plan
D) Restricted network plan
Which type of managed care plan has a contracted network of providers but also allows members to receive care from a nonparticipating provider?
A) Health maintenance organization
B) Preferred provider organization
C) Point-of-service plan
D) Restricted network plan
Which type of managed care plan provides coverage only if services are provided by members of its hospital, physician, or pharmacy panel?
A) Health maintenance organization
B) Preferred provider organization
C) Point-of-service plan
D) Restricted network plan
In a managed care plan, which type of provider is not part of a group under contract to provide services for set rates to members?
A) In-network
B) Out-of-network
C) Preferred
D) Nonregistered
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