HIT 210 HC Reimbursement Ch5 Managed Care and Integrated Delivery Systems
Exam: Service Management Tools, Carve-Out Contracts, Disease Management,
Evidence-Based Clinical Practice Guidelines, Subcapitation, Physician Incentives,
Medicare and Medicaid Physician Incentive Rules, Utilization Review,
Preadmission Review, Precertification, Gatekeeper Roles, Primary Care Provider
Functions, Staff, Group, and Hospital-Led HMOs, PPOs, POS Plans, IDS Models,
Out-of-Network Cost Sharing, Medical Necessity, Prior Authorization, Peer
Review, Appeals Processes, Case Management, Prescription Management,
Formularies, Episode-of-Care Reimbursement, Capitation, Global Payment,
Retrospective Fee-for-Service, Integrated Delivery System Billing, Physician
Contingency Reserves, Out-of-Plan Services, Patient Education, Financial
Incentives, Consumer-Directed Healthcare, Clinic Without Walls, Affiliation
Models, Medicare Advantage, MCO Survey Purposes, Well-Baby and Acute Care
Protocols, Evidence-Based Guidelines Implementation, and Quality Patient Care
Strategies in Managed Care Organizations Exam Questions Verified and Provided
with Complete A+ Graded Rationales Latest Updated 2026
This is a type of cost control used by MCOs.
Service management tools
Carve outs are:
Contracts that separate out services
, Disease management programs have had consistently positive effects.
False
Federal legislation encouraged the growth of health maintenance organizations.
True
Members with chronic conditions that receive appropriate assessment and therapeutic
procedures in an MCO is based on:
Evidence based-clinical practice guidelines
When specialists are reimbursed a portion of the capitated rate this is known as
Subcapitation
All are ways that MCOs work toward their goal of quality patient care except for:
Selecting providers carefully
Emphasizing the health of their population
Using care management tools
Targeting the enrollment of healthy patients
Targeting the enrollment of healthy patients
Exam: Service Management Tools, Carve-Out Contracts, Disease Management,
Evidence-Based Clinical Practice Guidelines, Subcapitation, Physician Incentives,
Medicare and Medicaid Physician Incentive Rules, Utilization Review,
Preadmission Review, Precertification, Gatekeeper Roles, Primary Care Provider
Functions, Staff, Group, and Hospital-Led HMOs, PPOs, POS Plans, IDS Models,
Out-of-Network Cost Sharing, Medical Necessity, Prior Authorization, Peer
Review, Appeals Processes, Case Management, Prescription Management,
Formularies, Episode-of-Care Reimbursement, Capitation, Global Payment,
Retrospective Fee-for-Service, Integrated Delivery System Billing, Physician
Contingency Reserves, Out-of-Plan Services, Patient Education, Financial
Incentives, Consumer-Directed Healthcare, Clinic Without Walls, Affiliation
Models, Medicare Advantage, MCO Survey Purposes, Well-Baby and Acute Care
Protocols, Evidence-Based Guidelines Implementation, and Quality Patient Care
Strategies in Managed Care Organizations Exam Questions Verified and Provided
with Complete A+ Graded Rationales Latest Updated 2026
This is a type of cost control used by MCOs.
Service management tools
Carve outs are:
Contracts that separate out services
, Disease management programs have had consistently positive effects.
False
Federal legislation encouraged the growth of health maintenance organizations.
True
Members with chronic conditions that receive appropriate assessment and therapeutic
procedures in an MCO is based on:
Evidence based-clinical practice guidelines
When specialists are reimbursed a portion of the capitated rate this is known as
Subcapitation
All are ways that MCOs work toward their goal of quality patient care except for:
Selecting providers carefully
Emphasizing the health of their population
Using care management tools
Targeting the enrollment of healthy patients
Targeting the enrollment of healthy patients
