Health Care Management Quiz 1 With Correct Answers 2024/2025

Advantages of IPA - correct answer--physicians can see patients of other insurers don't work for HMO physicians in smaller offices can join IPA and essence become large multi specialty group practice HMO can gain the services of many more physicians without having to employ them or build facilities for them some market power for physicians Advantages of POS plans - correct answer--Gives enrollees more choice - some state legislatures hav forced HMO's to offer POS plans Allowable - correct answer--Total amount the provider is paid per the contract with the insurer (includes deductibles, copays, coinsurance, and insurer payment) Ex. Per visit Rate Your contract calls for you to be paid $90 per outpatient PT visit $90 is allowable Even if visit lasts one hour and you bill $550, you will be paid $90. Pt pays 40 copay. Insurer then pays $50 Another name for FFS - correct answer--indemnity Assumption of Risk - FFS - correct answer--Insurer Assumption of Risk - HMO - correct answer--Provider Assumption of Risk - PPO - correct answer--Insurer/Provider At risk - insurer Insurer paid a fixed amount in form of premiums from employers, but payments insurer makes to providers are variable based on demand and volume of health services - correct answer--FFS Risk At risk: provider MAXimally, payer MINimally -insurer retains 100% of demand risk -provider now assumes 100% of volume risk - correct answer--Case Rate