Test Bank for Medical Insurance 8th Edition By Valerius-26 PDF

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51) One of the advantages of an HMO for patients who face difficult treatments is Disease/Case Management by assigning a A) referral. B) PCP. C) copayment. D) case manager. Answer: D Explanation: HMOs often assign case managers to work with patients who face difficult treatments. Difficulty: 2 Medium Topic: Health Maintenance Organizations Learning Objective: 01.04 Bloom's: Understand ABHES: 7.d Graduates will be able to: Process insurance claims CAHIIM: IV.A.1 Apply policies and procedures for the use of data required in healthcare reimbursement 52) Under a capitated rate for each plan member, which of the following does a provider share with the third-party payer? A) payments B) risk C) services D) the premium Answer: B Explanation: In a capitated plan, providers and payers share the risk of increased demand for medical services. Difficulty: 2 Medium Topic: Health Maintenance Organizations Learning Objective: 01.04 Bloom's: Understand ABHES: 7.d Graduates will be able to: Process insurance claims CAHIIM: IV.A.1 Apply policies and procedures for the use of data required in healthcare reimbursement

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