Top 56 Free CNA Practice Test Questions and Answers on Managed Care Plans
Top 56 Free CNA Practice Test Questions and Answers on Managed Care Plans are suitable for all people who are seeking for something new in the medical career. Even if not enough experience or knowledge to get a CNA certification, this total free CNA practice test online may be helpful in this situation. With many multiple choice questions collected from the CNA state exam, reaching to a win in the next exam is coming very close to you. Especially, through the user-friendly format, the engross to the attention will be easier and quicker. Take a visit to the questions, finish and get high points as you expected.
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Top 56 Free CNA Practice Test Questions and Answers on Managed Care Plans -Page 1
Healthcare provider or entity responsible for determining the healthcare services a patient or client may access. The gatekeeper may be a primary care provider, a utilization review or case management agency, or a managed care organization
Gatekeeper
Enrollee
Carve-out
Withhold
Cost containment measure to prevent unnecessary tests, treatments, medical devices, or surgical procedures
Third opinion
Cherry-picking
Closed panel
Capitation
Process of obtaining approval from a healthcare insurance company before receiving healthcare services
Subcapitation
Preadmission certification
Medical foundation
Prescription management
Optional managed care plan for Medicare Beneficiaries who are entitled to Part A, are enrolled in Part B, and live in an area with a plan. Types of plans available include health maintenance organization, point-of-service plan, preferred provider organization, and provider-sponsored organization
Medical foundation
Medicare Advantage (MA)
Managed care organization (MCO)
Case management
Entity that combines the provision of healthcare services. Characterized by (1) organized healthcare delivery system to a geographic area; (2) set of basic and supplemental health maintenance and treatment services; (3) voluntarily enrolled members; and (4) predetermined fixed, periodic prepayments for members coverage. Prepayments are fixed without regard to actual costs of healthcare services provided to members
Management service organization (MSO)
Health maintenance organization (HMO)
Provider-sponsored organization (PSO)
Managed care organization (MCO)
Hybrid managed care organization that is sponsored by self-insured (self-funded) employers or associations and exhibits characteristics of both health maintenance organizations and preferred provider organizations.
Integrated provider organization
Preferred provider organization (PPO)
Exclusive provider organization (EPO)
Management service organization (MSO)
Entity that integrates the financing and delivery of specified healthcare services. Characterized by (1) arrangements with specific providers to deliver a comprehensive set of healthcare services, (2) criteria for selecting providers, (3) quality assessment and utilization review, and (4) incentives for members to use plan providers.
Managed care organization (MCO)
Management service organization (MSO)
Health maintenance organization (HMO)
Preferred provider organization (PPO)
Method of payment for health services in which an individual or institutional provider is paid a fixed, per capita amount for each person enrolled without regard to the actual number of nature of services provided or number of person served.
Capitation
Cost sharing
Carve-out
Subcapitation
Process of obtaining approval from a healthcare insurance company before receiving healthcare services
Prior approval (authorization)
Medical foundation
Integrated provider organization
Physician-hospital organization
The process of determining whether a patient's medical care is necessary according to established guidelines and regulations. Cost containment measure that assesses the appropriateness of the setting for the healthcare service in the continuum of care and the level of service.
Subcapitation
Preadmission review
Capitation
Utilization review
Type of health maintenance organization (HMO) in which the HMO contacts with two or more medical groups and reimburses the groups on a fee-for-service or capitation basis
Network model
Network
Withhold pool
Staff model
Healthcare provider who provides, supervises, and coordinates the healthcare of a member. The PCP makes referrals to specialists and for advanced diagnostic testing. Family and general practitioners, internists, pediatricians, and obstetricians/ gynecologists are primary care physicians. Other PCPs include nurse practitioners physician assistants.
Per member per month (PMPM)
Managed care organization (MCO)
Primary care provider (PCP)
Medicare Advantage (MA)
Method of payment in which the third-party makes one consolidated payment to cover the services of multiple providers who are treating a single episode of care
Case management
Capitation
Global payment
Closed panel
Program focused on preventing exacerbations of chronic diseases and on promoting healthier lifestyles for patients and clients with chronic diseases
Prescription management
Disease management
Staff model
Case management
Groups of persons who may be compromised in their ability to give informed consent, who are frequently subjected to coercion in their decision making, or whose range of options is severely limited, making them vulnerable to healthcare quality problems. Examples include minority groups, poor people, homeless, and frail elderly
Preauthorization
Subcapitation
Vulnerable population
Medical foundation
Healthcare payment method in which providers receive one lump sum for all the care they provide related to a condition or disease.
Fee-for-service reimbursement
Episode-of-care reimbursement
Case management
Disease management
Overall measure of services provided for which no payment were received from the patient, client, or third-party payer.
Cost sharing
Closed panel
Community rating
Uncompensated care
Process of obtaining approval from a healthcare insurance company before receiving healthcare services
Utilization review
Third opinion
Community rating
Preadmission review
Provision of a healthcare insurance policy that requires policyholders to pay for a portion of their healthcare srvices; a cost-control mechanism.
Closed panel
Cost sharing
Formulary
Capitation
Contracts that separate out services or populations of patients or clients to decrease risk and costs.
Network
Carve-out
Formulary
Enrollee
Corporate, managerial entity that includes one or more hospitals, a large physician group practice, other healthcare organizations, or various configurations of these businesses.
Integrated delivery system
Preferred provider organization (PPO)
Integrated provider organization
Exclusive provider organization (EPO)
Type of integrated delivery system in which the individual physicians share administrative systems but maintain their separate practices and offices distributed over a geographic area.
Group practice (clinic) without walls (PWW, CWW)
Primary care physician (PCP)
Primary care provider (PCP)
Group practice model
Type of point-of-service plan in which the physicians that practice in a regional or community hospital organize the plan
Provider-sponsored organization (PSO)
Managed care organization (MCO)
Exclusive provider organization (EPO)
Preferred provider organization (PPO)
Type of health maintenance organization that provides hospitalization and physician's services through its own staff and facilities.
Cost sharing
Closed panel
Global payment
Managed care
Cost containment measure to prevent unnecessary tests, treatments, medical devices, or surgical procedures
Cost sharing
Capitation
Closed panel
Second opinion
Multipurpose, nonprofit service organization for physicians and other healthcare providers at the local and county levels. As managed care organizations, medical foundations have established preferred provider organizations, exclusive provider organizations, and management service organizations. Emphases are freedom of choice and preservation of the physician-patient relationship
Capitation
Third opinion
Medical foundation
Pre-certification
Amount of money paid monthly for each individual enrolled in a capitation-based health insurance plan
Primary care physician (PCP)
Special needs plan (SNP)
Primary care provider (PCP)
Per member per month (PMPM)
Portion of providers capitated payments with managed care organizations deduct and hold to create an incentive for efficient or reduced use of healthcare services
Capitation
Withhold
Formulary
Gatekeeper
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