Which is responsible for supervising and coordinating health care services for enrollee?

Q: Who is responsible for the health of a group of enrollees?

Primary Care Physician (PCP) A generalist physician who, under certain health care plans, is accountable for the total health services of enrollees.

1.
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The intent of managed health care was to
- A.
  Dramatically improve the healthcare delivery system in the united states
- B.
  Have employees of a managed care organization provide patient care
- C.
  Replace fee- for-service plans with affordable, quality care to healthcare consumers
- D.
  Retrospectively reimburse patient for healthcare services provided
2.
What term best describes those who receive managed healthcare plan services?
- A.
  Employees
- B.
  Enrollees
- C.
  Payers
- D.
  Providers
3.
The medical center received a $100,000 capitation payment in January to cover healthcare cost of 150 managed care enrollees. By the following January,$80,000 had been expended to cover services provided. The remaining $20.000 is
- A.
  Distributed equally among the 150 enrollees
- B.
  Retained by the medical center as profit
- C.
  Submitted to the managed care organization
- D.
  Turned over to the federal government
4.
A non profit organization that contracts with and acquires the clinical and business assets of physician practices is called?
- A.
  Medical foundation
- B.
  Medicare risk programs
- C.
  Physician-hospital organizations
- D.
  Triple opttion plans
5.
A ________ is responsible for supervising and coordinating healthcare services for enrollees
- A.
  Case manager
- B.
  Primary care provider
- C.
  Third party administrator
- D.
  Utilization review manager
6.
The term that describes requirements created by accreditation organizations is
- A.
  Laws
- B.
  Mandates
- C.
  Regulations
- D.
  Standards
7.
Arranging appropriate healthcare services for discharged patients
- A.
  Pre-admissions review
- B.
  Preauthorizaton
- C.
  Concurrent review
- D.
  Discharge planning
8.
Review for medical necessity for inpatient care prior to admission
- A.
  Concurrent review
- B.
  Preauthorization
- C.
  Pre-admission review
- D.
  Discharge planning
9.
Review for medical necessity of tests/procedures ordering during inpatient hospitalization
- A.
  Discharge planning
- B.
  Preauthorization
- C.
  Concurrent review
- D.
  Pre-admission review
10.
Grants prior approval for reimbursement of a healthcare service
- A.
  Pre-admission review
- B.
  Preauthorization
- C.
  Concurrent review
- D.
  Discharge planning
11.
Contract network of healthcare providers that provide care to subscribers for a discounted fee
- A.
  EPO
- B.
  IDS
- C.
  HMO
- D.
  POS
- E.
  PPO
12.
Organization of affiliated providers sites that offer joint healthcare services to subscribers
- A.
  EPO
- B.
  IDS
- C.
  HMO
- D.
  POS
- E.
  PPO
13.
Provides benefits to subscribers who are required to receive services from network providers
- A.
  EPO
- B.
  IDS
- C.
  PPO
- D.
  POS
- E.
  HMO
14.
Provides comprehensive healthcare services to voluntarily enrolled members on a prepaid basis
- A.
  EPO
- B.
  IDS
- C.
  HMO
- D.
  POS
- E.
  PPO
15.
Patients are free to use the managed care panel or self refer to non-managed care providers
- A.
  EPO
- B.
  IDS
- C.
  HMO
- D.
  POS
- E.
  PPO

Who has the primary responsibility for setting the overall direction of the hospital?

The board of directors has primary responsibility for setting the overall direction of the hospital.

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

Also called individual practice association (IPA); type of HMO where contracted health services are delivered to subscribers by physicians who remain in their independent office settings.

What are some of the main responsibilities of the members of a healthcare team quizlet?

provide care, advice and emotional support to patients and families. Create awareness about certain health conditions. Operate medical equipment, perform tests and study results. Educators about disease or injuries and how to manage treatment at home.

Who is responsible for the health of a group of enrollees?

Primary Care Physician (PCP) A "generalist" physician who, under certain health care plans, is accountable for the total health services of enrollees.

Which is responsible for supervising and coordinating health care services for enrollee?

Who has the primary responsibility for setting the overall direction of the hospital?

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

What are some of the main responsibilities of the members of a healthcare team quizlet?

Who is responsible for the health of a group of enrollees?

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