A point-of-service (POS) plan allows members to choose a health maintenance organization (HMO) or preferred provider organization (PPO) once a year at open enrollment.
Indicate whether this statement is true or false.
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Q. 2) The majority of payments received in a medical facility come from insurance carriers.
Indicate whether this statement is true or false.
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Q. 3) A primary care physician (PCP) in a health maintenance organization (HMO) can be an OB/GYN.
Indicate whether this statement is true or false.
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Q. 4) Primary care physicians (PCPs) are sometimes referred to as gatekeepers because patients with HMO plans must obtain referrals from them to see specialists.
Indicate whether this statement is true or false.
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Q. 5) Traditional insurance plans tend to cover more preventive services than health maintenance organizations (HMOs).
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Q. 6) The first example of a managed care plan is the Kaiser plan for shipyards and steel mill employees in 1942.
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Q. 7) A goal of managed care is for the patient to receive care in the most appropriate and most restrictive setting.
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Q. 8) If a physician has ordered surgery for a patient, a managed care organization (MCO) case manager may disallow an inpatient stay if the MCO guidelines designate the procedure as best suited for outpatient care.
Indicate whether this statement is true or false.
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Q. 9) Managed care is a method of controlling healthcare costs and the delivery of care.
Indicate whether this statement is true or false.
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Q. 10) All health insurance contracts define medical necessity in the same way.
Indicate whether this statement is true or false.
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