When a corporation uses employee health premiums to build an account to pay for employee health issues, it is called:
a. an HMO.
b. a PPO.
c. self-insurance.
d. an EPO.
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Q. 2) Who normally contracts with an MSO?
a. Medical group
b. Independent hospital
c. Independent practitioner
d. All of the above
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Q. 3) HMOs may charge a _________________ for prescriptions.
a. copayment
b. coinsurance
c. monthly fee
d. premium
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Q. 4) Which type of insurance plan is more likely to offer preventative health programs such as smoking cessation?
a. Indemnity
b. PPO
c. Private practitioner
d. HMO
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Q. 5) What do self-insured companies usually do to manage the health claims process?
a. Create a new department
b. Use a third-party department
c. Use a third-party administrator
d. Add to the job descriptions already employed
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Q. 6) An Exclusive Provider Organization pays health care costs for:
a. providers of health care.
b. nurses in health care.
c. services provided in an in-network setting/by an in-network provider.
d. hospital services only.
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Q. 7) What is an MSO?
a. Maintenance Service Organization
b. Management Service Organization
c. Member Service Office
d. Member Service Organization
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Q. 8) A Preferred Hospital Organization bands together hospitals and providers to negotiate contracts with:
a. payer organizations.
b. HMOs.
c. IPAs.
d. referral sources.
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Q. 9) When a patient in a PPO insurance program sees a provider who is out-of-network, which of the following apply?
a. The patient may have to file the insurance claim.
b. The patient may have to pay a higher out-of-pocket amount.
c. The patient may have reduced benefits.
d. All of the above
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Q. 10) In-network providers have which of the following benefits in a PPO insurance program?
a. Reduced provider fees
b. Referrals from the insurance company
c. Reduced office staff needs
d. Automatially increased revenue
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