CRCR H EXAM questions with solutions

CRCR H




HMO (Health Maintenance Organization) - answerA group of medical providers is
identified to furnish services at lower than usual fees

PPO Preferred Provider Organization - answera health plan that provides
comprehensive healthcare services, within a designated population on a prepayment
basis

POS (Point of Service Plan) - answerMembers can refer themselves outside the plan
and still get some coverage

CDHP Consumer direct Health plans - answerSubscriber agrees to a high initial
deductible in return for lower premiums

HMO (managed care plan) - answerhealth maintenance organization

PPO (managed care plan) - answerPreferred Provider Organization

EPO (managed care plan) - answerExclusive Provider Organization

POS (managed care plan) - answerPoint of service plan

CDHP (managed care plan) - answerConsumer Directed Health Plan

Name the managed care plans that have an arrangement with the healthcare to offer
services at a reduced cost. - answerHMO, PPO, EPO, POS, CDHP, Medicare
Advantage Plans and Medicaid HMO plans

Manage care health plans uses what to determine if care is medically necessary -
answerAuthorizations and utilization

Part of the authorizations and utilization process for managed care to determine
medically necessary the review includes - answerpre-cert / pre-auth, referrals,
notification, site of service limits, case management and discharge planning