1. What is the primary goal of Managed Care Organizations (MCOs)?
a) To increase healthcare costs
b) To provide comprehensive services
c) To limit access to healthcare providers
d) To manage patient care and control healthcare costs
Answer: d) To manage patient care and control healthcare costs
Rationale: MCOs aim to provide quality care while controlling costs
through various mechanisms such as provider networks, negotiated rates,
and utilization review.
2. Which model of managed care emphasizes a strong primary care
foundation?
a) Preferred Provider Organization (PPO)
b) Health Maintenance Organization (HMO)
c) Point of Service (POS)
d) Exclusive Provider Organization (EPO)
Answer: b) Health Maintenance Organization (HMO)
Rationale: HMOs typically require members to choose a primary care
physician who coordinates all healthcare services and provides referrals to
specialists.
3. In a Capitation payment model, how are providers paid?
a) Based on the number of services provided
b) A set fee for each enrolled person assigned to them, per period of
time
c) Based on the quality outcomes of the care provided
d) A percentage of the reduced costs they achieve for the MCO
Answer: b) A set fee for each enrolled person assigned to them, per
period of time
Rationale: Capitation involves payment of a fixed amount for each
patient assigned to a provider for a set period, regardless of the actual
number or nature of services provided.
4. What is the role of a Gatekeeper in an HMO?
a) To process insurance claims
b) To provide specialized care
c) To coordinate patient care and control access to specialists
d) To negotiate contracts with providers
Category | exam bundles |
Comments | 0 |
Rating | |
Sales | 0 |