NWCA study guide Exam Questions and
Answers (Most Recent Version, Complete
Study Material)
Managed Care Organization (MCO) - Correct Answers
✅Combines functions of health insurance, delivery of care
and administration
Exclusive Provider Organization (EPO) - Correct Answers
✅Services covered only if use doctors, specialists or
hospitals in plans network (except in hospitals)
Health Maintenance Organization (HMO) - Correct Answers
✅Limits coverage to care from doctors who work for or
contract with the HMO, generally won't cover out of network
care except in emergency. May require to live or work in its
service area.
Point of Service (POS) - Correct Answers ✅Pay less if you
use doctors, and other health care providers that belong to
the plans network, required to get a referral from primary
care doctor in order to see specialist
Quality Improvement Organization (QIO) - Correct Answers
✅Physician can hose whether or not accept Medicare
patients, who are seeking non medical services, signs an
agreement and May sign a participating provider
agreement(PAR)
, NWCA study guide Exam Questions and
Answers (Most Recent Version, Complete
Study Material)
Preferred Provider Organization (PPO) - Correct Answers
✅Pay less if use providers in plans network. Can use
providers outside of network without a referral for N
additional cost.
DHHS stands for - Correct Answers ✅Department of health
and human services
Medicare Administrative Contractor (MAC) is - Correct
Answers ✅A private health care insurer awarded
geographic jurisdiction to process medicare A y B
Medicare A covers - Correct Answers ✅Hospital care,
skilled nursing facility care, nursing home, ( as long as
custodial care isn't the only type of care needed), hospice, o
e health services
Part b covers - Correct Answers ✅Medically necessary
services, preventative services
Part C is - Correct Answers ✅Medicare advantage plan,
often a HMO, OR PPO, or other health plan that also offers
prescription drug coverage, get A,B, and D
Answers (Most Recent Version, Complete
Study Material)
Managed Care Organization (MCO) - Correct Answers
✅Combines functions of health insurance, delivery of care
and administration
Exclusive Provider Organization (EPO) - Correct Answers
✅Services covered only if use doctors, specialists or
hospitals in plans network (except in hospitals)
Health Maintenance Organization (HMO) - Correct Answers
✅Limits coverage to care from doctors who work for or
contract with the HMO, generally won't cover out of network
care except in emergency. May require to live or work in its
service area.
Point of Service (POS) - Correct Answers ✅Pay less if you
use doctors, and other health care providers that belong to
the plans network, required to get a referral from primary
care doctor in order to see specialist
Quality Improvement Organization (QIO) - Correct Answers
✅Physician can hose whether or not accept Medicare
patients, who are seeking non medical services, signs an
agreement and May sign a participating provider
agreement(PAR)
, NWCA study guide Exam Questions and
Answers (Most Recent Version, Complete
Study Material)
Preferred Provider Organization (PPO) - Correct Answers
✅Pay less if use providers in plans network. Can use
providers outside of network without a referral for N
additional cost.
DHHS stands for - Correct Answers ✅Department of health
and human services
Medicare Administrative Contractor (MAC) is - Correct
Answers ✅A private health care insurer awarded
geographic jurisdiction to process medicare A y B
Medicare A covers - Correct Answers ✅Hospital care,
skilled nursing facility care, nursing home, ( as long as
custodial care isn't the only type of care needed), hospice, o
e health services
Part b covers - Correct Answers ✅Medically necessary
services, preventative services
Part C is - Correct Answers ✅Medicare advantage plan,
often a HMO, OR PPO, or other health plan that also offers
prescription drug coverage, get A,B, and D
