What are the commonly recognized types of HMOs? In what model does an HMO contract with more than one group practice provide medical services to its members? b. T or F: In the medical management area, committees serve to diffuse some elements of responsibility and allow important input from the field into procedure and policy or even into case-specific interpretation of existing policy. Key common characteristics of PPOs include: Prepayment for services on a fixed, per member per month basis. *a self-funded employer plan Commonly recognized types of HMOs include: a, b and d only (IPAs, Network, Staff and Group). D- Prepaid group practices, D- prepaid group practices 'health plan employer data and information set' is the less widely used set of measures for reporting on managed behavioral healthcare. Depending on how many plans are offered in your area, you may find plans of all or any of these types at each metal level - Bronze, Silver, Gold, and Platinum. Abstract. D- All the above. 5 - A key difference between an HMO and a PPO is that the latter provides enrollees with more flexibility to see providers outside of the plan's provider network, although cost sharing . PPOs generally offer a wider choice of providers than HMOs. considerations for successful network development include geographic accessibility and hospital related needs, state and federal regulations consistently apply network access standards to: PPOs tend to have higher monthly premiums in exchange for the flexibility to use providers both in and out of network without a referral. 28 related questions found What is a PPO plan? Who is eligible for each type of program? Like virtually all types of health coverage, a PPO uses cost-sharing to help keep costs in check. The Balance Budget Act (BBA) of 1997 caused a major increase in HMO enrollment. The remaining balance is covered by the person's insurance company. The original impetus of HMOs development came from: More than 90% of members of employer-sponsored health plans have access to prescription drug coverage, and over 90% of all prescriptions in the U.S. are reimbursed by insured prescription drug benefit programs. In markets with high levels of managed care penetration, hospitals are usually paid using a sliding scale discount on charges method. C- State Medicaid programs *they do not accept capitation risk Medical license Key common characteristics of PPOs do not include: a. The Crown Bottling Company has just installed a new bottling process that will fill 161616-ounce bottles of the popular Crown Classic Cola soft drink. \text{\_\_\_\_\_\_\_ e. Building}\\ A Health Savings Account State Mandated benefits coverage applies to all types of health benefits plans that provide coverage in that state. What has been the benefit for both sets of individuals who are the. Point-of-service (POS) plans are a type of Medicare managed care plan that acts as a hybrid HMO and PPO policy. False Reinsurance and health insurance are subject to the same laws and regulations. Total annual out-of-pocket expenses (other than premiums) for covered benefits not to exceed $6,250. Category: HSM 546HSM 546 HOM 5307 Flashcards | Chegg.com A- Validity What are the hospital consolidation trends? individual health insurance is less expensive for the same level of coverage than are group health benefit plans, false the most effective way to induce behavior changes in physician is through continuing medical education, T/F A copay, short for copayment, is a fixed amount a healthcare beneficiary pays for covered medical services. He hires an attorney to determine whether he and Mary were legally married. D- All of the above, managed care is best described as: It paid cash dividends of7,500ofcommonstockandpaidnodividends.b.Thecompanyissuednocommonstock.Itpaidcashdividendsof 13,000. C- Requires less start-up capital Which of the following provider contract Clauses state that the provider agrees not to Sue or assert any claim against the enrollee for payments that are the responsibility of the payer? The pooling of unequal risk means happens when healthy and sick people are in the same risk pool. PPOs.). _______a. A PPO is a type of health insurance that is used to help cover the cost of medical treatment. Key common characteristics of PPOs do not include : a. . The same methodology used to pay a hospital for inpatient care is usually also use to pay for outpatient care. The Court held that the law was a prior restraint on freedom of speech and of the press under the 1st Amendment. As the drivers of globalization continue to pressure both the globalization of markets and the globalization of production, we continue to see the impact of greater globalization on worldwide trade patterns. Which organization(s) need a Corporate Compliance Officer (CCO)? Board of Directors has final responsibility for all aspects of an independent HMO. ___________ is not used in the Affordable Care Act to describe a benefit level based on the amount of cost-sharing. PSOs, created by the BBA of 1997, proved to be very popular and successful. 1. . The limits in 2011 for families are: A deductible of $2,500 or more. Which of the following forms of hospital payment contain no elements of risk sharing by the hospital? commonly, recognized types of hmos include all but. C- Consumer choice & Utilization management 2 points Key common characteristics of PPOs do NOT include: Limited provider panels O Discounted payment rates Consumer choice O Utilization management Benefits limited to in-network care. PPOs feature a network of health care providers to provide you with healthcare services. 3. Advantages of IPA do not include. The function of the board is governance: overseeing and maintaining final responsibility for the plan. T or F: Hospital consolidation has been blocked more often than not by the Department of Justice (DOJ) and/or the Federal Trade Commission (FTC). Large employers often provide employees with options Set up the null and alternative hypotheses for this hypothesis test. Pre-certification that includes the authorized coverage length of stayConcurrent, or continued stay, review by UM nurses using evidence-based clinical criteriaDischarge planning prior to admission or at the beginning of the stay. a. private health insurance company b. The employer manages administrative needs such as payroll deduction and payment of premiums. Providers Health care professionals that are not a part of the PPO are considered out-of-network. A deductible is the amount that is paid by the insured before the insurance company pays benefits. B- Pharmacy data The first important characteristic of PPO is that it allows its plan members to visit any doctor or hospital without referrals from the members' Primary Care Physicians (PCP). All three methods used to manage utilization during the course of a hospitalization. Discounted payment rates c. Consumer choice d. Utilization management e. Benefits limited to in-network care c. Consumer choice 9.