HCA 46 Questions And Answers
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Terms in this set
46
Who is the third-party in the medical insurance relationship?
insurance company
A PPO may offer:
low deductible and higher premium plan
higher deductible with lower premium plan
higher deductible with lower premium plan
Health maintenance organizations are organized by which business models?
group models
independence practice models
staff models
independence practice models
staff models
Plans that are paid by a salary include:
group health maintenance organization
staff health maintenance organization
staff health maintenance organization
Dr. Jones uses the allowed charge method for payment. He charges $100 for an office visit. The allowed charge is $120. How much will the insurance company reimburse Dr. Jones for a visit?
$100
Who is legally responsible for paying for services?
patient
Advantages of a PPO plan can include:
flexibility to see out-of-network providers
large network of providers
prescription drug coverage
large network of providers
prescription drug coverage
Health maintenance organizations are licensed by:
state.
Which plans include a discounted fee-for-service?
consumer-directed health plan
group health maintenance organization
point-of-service plan
preferred provider organization
group health maintenance organization
point-of-service plan
preferred provider organization
What determines if a provider receives the allowed charge?
payer's billing rules
provider's status in a plan or program
provider's usual charge for procedure or service
provider's status in a plan or program
provider's usual charge for procedure or service