DLM (ASCP) FINAL EXAM |70 COMPLETE QUESTIONS WITH EXPERT SOLUTIONS |
2026 LATEST UPDATED | GET A+
1. What is the primary goal of managed care health systems?: To contain
costs by controlling the type, level, and cost of services provided.
2. What is a capitation system in the context of managed care?: A payment
system that limits what a health provider is paid for patient services under
a managed care plan.
3. What are two common examples of managed care organizations?: Health
maintenance organizations (HMOs) and preferred provider organizations
(PPOs).
4. What is the typical provider network limitation for individuals insured
under an HMO or PPO?: They generally receive care only from providers on
the plan's panel.
5. What is 'utilization review' in managed care?: A process where the delivery
of medical services is scrutinized to determine if the services are necessary.
, 6. Who manages Medicare-Medicaid (MC-MC) programs?: The programs are
managed by individual states under federal guidelines.
7. What are the two main payment options some states offer for MC-MC
patients?: Managed care plans (HMOs or PPOs) or a fee-for-service system.
8. What are Medicare Advantage Plans?: Plans where the state MC-MC office
contracts with an HMO or PPO to provide services, accepting the MC-MC
fee schedule for payment.
9. How does the fee-for-service system under MC-MC determine hospital pay-
ments?: Payments are based on specific patient diagnosis groups (DRGs)
and codes, with caps according to a specific schedule.
10. What is the primary advantage of a fee-for-service system for physician
groups regarding laboratory tests?: Revenue for laboratory tests is based on
the volume of services provided.
11. What does it mean for a physician group to take an 'assignment' from
Medicare-Medicaid?: The provider agrees to accept the Medicare-approved
amount as the total payment for covered services.
2026 LATEST UPDATED | GET A+
1. What is the primary goal of managed care health systems?: To contain
costs by controlling the type, level, and cost of services provided.
2. What is a capitation system in the context of managed care?: A payment
system that limits what a health provider is paid for patient services under
a managed care plan.
3. What are two common examples of managed care organizations?: Health
maintenance organizations (HMOs) and preferred provider organizations
(PPOs).
4. What is the typical provider network limitation for individuals insured
under an HMO or PPO?: They generally receive care only from providers on
the plan's panel.
5. What is 'utilization review' in managed care?: A process where the delivery
of medical services is scrutinized to determine if the services are necessary.
, 6. Who manages Medicare-Medicaid (MC-MC) programs?: The programs are
managed by individual states under federal guidelines.
7. What are the two main payment options some states offer for MC-MC
patients?: Managed care plans (HMOs or PPOs) or a fee-for-service system.
8. What are Medicare Advantage Plans?: Plans where the state MC-MC office
contracts with an HMO or PPO to provide services, accepting the MC-MC
fee schedule for payment.
9. How does the fee-for-service system under MC-MC determine hospital pay-
ments?: Payments are based on specific patient diagnosis groups (DRGs)
and codes, with caps according to a specific schedule.
10. What is the primary advantage of a fee-for-service system for physician
groups regarding laboratory tests?: Revenue for laboratory tests is based on
the volume of services provided.
11. What does it mean for a physician group to take an 'assignment' from
Medicare-Medicaid?: The provider agrees to accept the Medicare-approved
amount as the total payment for covered services.
