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Course 3A_L1 - Quiz 1

 

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1)
In this lesson, we said that a State uses CAPITATION CONTRACTS in public health care plans such as Medicaid or Medicare, in order to CONTROL THE TOTAL COST of health care within the state.
 
True False
 
2)
This lesson says that one thing that we may find in a managed care plan is:
 
reduction of the pre-managed care Provider Fee Structure by 50%.
the Federal government assuming responsibility for all health care if the HMO fails..
four or more HMOs doing business in the region at the same time.
the the HMO using strategic methods to control their day to day cash flow.
disqualification of current providers from participation.
 
3)
Federal regulations require an HMO to provide the most intensive level of care if the patient wants it, even if the admission is not 'Medically Necessary'.
 
True False
 
4)
The Managed Care Company authorizes _________________ in order to CONTROL COST.
 
the treatment that the enrollee agrees to accept,
treatment on a 'first come first served' basis,
only the care that is Medically Necessary,
the cheapest treatment available,
 
5)
CAPITATION or CAPITATED contracts are defined in this Module. Please choose the correct answer below, based upon information presented in this course.
 
Under a capitation contract, the 'AT RISK' entity (usually an HMO or similar) must provide or arrange medically necessary treatment for all ENROLLED, ELIGIBLE members who present for services.
The Capitation Contract arrangement pays the contractor XX amount of dollars (such as $6.25 or $11.30) per member per month (p.m.p.m.), for each member enrolled in the plan, usually thousands of individuals.
The assumption is that only a small percent of the total enrolled population will actually seek healthcare services, and that only a small percent of those who seek services will require intensive services
All of the above
None of the above
 
6)
One of the problems with managed care is that the Managed Care Companies are NOT allowed to SHIFT where and how the money is spent for treatment services.
 
True False
 
7)
To be successful in a Managed Care system, treatment providers
 
should stick to the traditional ways that they have always done treatment, because they do those things well.
should emphasize that 'we have always done things this way', when requesting authorization from the HMO.
may need to learn new ways to document treatment and the need for treatment.
should attempt to take on CAPITATION CONTRACTS in their state, instead of letting HMOs manage such contracts.
 
8)
This lesson makes the comment that
 
despite the risks, Capitation Contracts can work.
providers can benefit from the shift to managed care.
the key to healthcare COST CONTAINMENT is the process of determining MEDICAL NECESSITY of treatment.
not all forms of CAPITATION are workable or desirable.
All of the above
 

 

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