1. What is the primary difference between direct contracting and thirdparty contracting in the healthcare industry?
A. Direct contracting involves an agreement between the payer and
provider, while third-party contracting involves a third-party intermediary.
B. Direct contracting involves a fixed fee schedule, while third-party
contracting involves a negotiated fee-for-service arrangement.
C. Direct contracting is limited to specific services, while third-party
contracting covers a range of services.
D. Direct contracting is more expensive than third-party contracting due to
administrative costs.
Answer: A - Direct contracting involves an agreement between the payer
and provider, while third-party contracting involves a third-party
intermediary. Rationale: Direct contracting allows for direct negotiation
between the payer and provider, while third-party contracting involves a
third-party intermediary, such as an insurance company or managed care
organization.
2. What is a Silent PPO in the context of healthcare contracting?
A. A type of PPO that doesn't require prior authorization for services.
B. A PPO that operates without the knowledge or consent of the provider.
C. A PPO that offers discounted rates to members but not to providers.
D. A PPO that only covers services from out-of-network providers.
Answer: B - A PPO that operates without the knowledge or consent of the
provider. Rationale: A Silent PPO is a type of PPO that allows payers to
access discounted rates without the knowledge or consent of the provider,
often leading to lower reimbursement rates.
3. What is the main difference between a non-directed PPO and a
traditional PPO?
A. Non-directed PPOs require members to choose a primary care provider,
while traditional PPOs do not.
B. Non-directed PPOs prioritize cost savings over network choice, while
traditional PPOs focus on provider network access.
C. Non-directed PPOs only cover services from in-network providers,
while traditional PPOs offer out-of-network coverage.
D. Non-directed PPOs are typically more expensive for members
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