Med 1840 Mid

The contract issued by a payer, plan document or any other legally enforceable instrument: 

Providers who treat patients covered by a capitation plan have an incentive to provide:

PPO plans never have an annual deductable

Regularly scheduled payments made to purchase an insurance policy is known as: 

In a MCO, a PCP is typically any of the following except: 

The Privacy Compliance Officer must be familiar with only federal regulations

This fee is determined by what Dr's with similar training & in a certain area typically charge

These are standards or behavior for licensed medical staff: 

An example of a certification agency is the 

When the MCO if referring to the term "gatekeeper" they are actually referring to:

Contracts between the physician and MCO are negotiated by the 

Along with MCO contracts, patients are provided with protection & should be made aware of: 

The services provided to covered persons under the terms of benefit plan are called: 

The amount that an insured person must pay at each visit is called a copayment 

The US FDA may require PHI to collect or report the following 

Which of the following is true of the Patients Bill of Rights

Contracts between the physician & MCO should state the following except 

Under a capitation, the Dr is compensated based on a fixed prepaid payment, referred to as: 

PPO is the abbreviation for Plan Provider Options

All of the following are HIPAA codes except: 

Who may sign patient's consent according to HIPAA?

The unique identifier for employers (business entities) that sponsor health plans is the: 

The HITECH Act introduced which concept in regard to electronic health information?

Method of controlling healthcare costs & ensuring that medical care is available to everyone is

Coinsurance is paid by the provider

This regulates the use and disclosure of certain health information held by a covered entity 

The Privacy Rule grants individuals the right to request inaccurate PHI be corrected

Any info held by a covered entity that concerns health status, provision of health care, etc is

Utilization guidelines are used to: 

What is the department who handles all account receivables & billing, if not contracting to CBO

The Patients Bill of Rights consists of this principle: 

The following purposes of Medical Reform are true except: 

The criminal penalties for HIPAA violations can include fines & what prison sentences?

Healthcare providers who achieve the standards of each HITECH stage by a date were eligible for

HMO's and PPO's are the same

Which is a characteristic of a PPO?

To avoid ethical conflicts, the MA must do what to ensure they're not held liable in court

the subscriber in a HMO can also be called a(an)

Licensed professional, including the physician or entity that has entered into MCO contract is:

COB is defined as: 

The Patient's Bill of Rights was adopted in 1998 by the: 

When might a MCO still ask a Dr. to be in their network?

The annual amount to be paid out of pocket before insurance begins payments is called

What does NCQA stand for?

This person could also be known as a receptionist

In the Pt's Bill of Rights, info disclosure provides patients with the right to info that is: 

Who does research & accurately codes diagnosis'?

MCO's evaluate the provider through this process: 

utilization guidelines are used to: 

The Privacy Rule covers not only the release of PHI but also:

Managed care contract may offer different types of payment, which may include the following

The unique identifier for physicians, nurses and other healthcare professionals, facilities is:

The section that lists all services that are considered covered is called: 

The HITECH Act is part of the 

Accrediting agency that require an MCO plan must demonstrate it has a credentialing process: 

A centralized billing office typically contracts with a physician's office to do what? 

The Privacy Rule pertains to electronic PHI

All of the following are true regarding a HMO plan EXCEPT

The provision in the Pt's Bill of Rights that allows patients the right to review their records