A ____________ is a primary care provider who decides whether or not a patient is referred to a specialist.

A _____________ is something an employer buys from an insurance-type company which guarantees payment in the event an employee causes a loss to the company (e.g. steals from the company).

A _______ _______ ________ is a type of business agreement between a medical provider and an insurer in which the fees for specific services are predetermined for an established group of clients. The clients must use this medical provider or else pay more to see a provider not on the list.

A type of business which is owned by a single individual is called a ______ _________.

HMO's, PPO's, and government-funded medical entities are all examples of __________ _________.

A _________ agreement is where health care providers are paid a fixed monthly fee to provide a range of services for each HMO member in their care.

A __________ ___________ __________ is an organization that pays medical providers a prepaid amount to provide services to an enrolled group of persons. The medical provider may be either an employee of the organization (like a doctor working for Kaiser) or an independent provider who enters into a contractual agreement with the organization.

A type of corporation in which licensed individuals organize to render professional services to the public is called a ___________ __________ ____________.

A _______________ is an amount of money a member must pay towards a covered service before the member's insurer begins to make any payments.

A ________-_____-_________ arrangement is when a provider is paid for each service that he/she performs for a patient.

A __________ ____________ is a type of business arrangement in which many practitioners join together to provide medical care, consultation, diagnosis, and treatment to clients. The equipment and personnel are used jointly and the income is distributed according to a predetermined agreement.

A ____________ is a specific amount or percentage which a member has to pay as part of the service rendered. Frequently it is paid as part of the cost of a prescription but is increasingly being charged for other services e.g. clinic visits, hospital stays.

A type of managed care which rewards medical providers for improving the quality of their patients' care by meeting specific goals is called ________ ___ _________.

A type of business involving the association of two or more individuals who are co-owners of the business is called a _____________.

An ______-_____ ______ is where members can seek treatment from providers outside of their network but will have to pay more to do so.

A type of business arrangement where two or more organizations join together to provide services is called a ________ _________. An example would be when a physician group and hospital come together to provide combined services to their clients.

A type of business owned by a single individual is a:

a. professional service corporation

b. sole proprietorship

c. preferred provider organization

d. partnership

b. sole proprietorship

A professional service corporation is:

a. a business which is incorporated by licensed individuals in order to render a professional service to the public.

b. a type of business involving the association of two or more individuals who are co-owners of the business.

c. a type of business management where hospitals, physicians, and clinics form to offer client care.

d. an agreement between a medical service provider and an insurer organization in which fees for specific services are predetermined for an established group of clients.

a. a business which is incorporated by licensed individuals in order to render a professional service to the public.

A preferred provider organization (PPO) is:

a. a contractual agreement between a medical provider and an insurer organization in which the provider agrees to provide care to an established group of clients usually for a predetermined amount.

b. a type of managed care which encourages providers to improve the quality of their clients' care by giving them financial incentives to meet specific goals.

c. when members or clients can seek treatment from provider outside of their health care plan but pay more to do so.

d. where a primary care provider controls referrals to specialists.

a. a contractual agreement between a medical provider and an insurer organization in which the provider agrees to provide care to an established group of clients usually for a predetermined amount.

A bond is an insurance contract which:

a. rewards a medical provider for improving the quality of their clients' care.

b. pays providers for each service performed.

c. pays a fixed monthly fee for a range of services for each HMO member in their care.

d. pays a specified sum to an employer in the event of a financial loss to the employer caused by an act of the employee.

d. pays a specified sum to an employer in the event of a financial loss to the employer caused by an act of the employee.

A system by which health care providers are paid a fixed monthly fee for a range of services for each HMO member in their care is called:

a. pay for performance

b. fee-for-service

c. co-payment

d. capitation

d. capitation

A type of managed care which encourages providers to improve the quality of their clients' care and rewards them financially for reaching specific goals is called a:

a. preferred provider organization (PPO)

b. health maintenance organization HMO)

c. Pay for Performance (P4P)

d. capitation agreement

c. Pay for Performance (P4P)

A type of business involving the association of two or more individuals who are co-owners of their business is called a:

a. preferred provider organization (PPO)

b. health maintenance organization (HMO)

c. partnership

d. professional service corporation

c. partnership

A specific dollar amount or percentage which a member has to pay as part of the services he or she receives each time is called a:

a. fee-for-service

b. co-payment

c. liability

d. deductible

b. co-payment

A deductible is a(n):

a. arrangement where members can seek treatment from providers outside the health care plan but pay more to do so.

b. cost-sharing arrangement in which the member pays a set amount of money towards covered services before the insurer begins to make payments.

c. amount a medical provider is paid on a monthly basis.

d. fixed amount that a member must pay every time they receive a medical service.

b. cost-sharing arrangement in which the member pays a set amount of money towards covered services before the insurer begins to make payments.

A provision which allows for members or clients to seek treatment from providers outside their health care plan but pay extra to do so is called:

a. a co-payment.

b. a preferred provider organization.

c. an opt-out option.

d. a deductible.

c. an opt-out option.

A fee-for-service arrangement:

a. requires pre-payment by the insurer to the medical provider.

b. is when providers are paid for each service they render.

c. is the primary reimbursement arrangement for HMO's  and medical service providers.

d. is a system whereby a gatekeeper decides if patients see a specialist.

b. is when providers are paid for each service they render.

A term referring to a primary care provider who is responsible for referring members to specialists is called a:

a. preferred provider organization (PPO).

b. joint venture.

c. sole proprietorship.

d. gatekeeper.

d. gatekeeper.

An arrangement for health care in which an organization, such as an insurance company, an HMO, or another type of doctor-hospital network, acts as an intermediary between the person seeking care and the physician is called:

a. managed care.

b. a professional service corporation.

c. a joint venture.

d. a group practice.

a. managed care.

An arrangement whereby prepaid health care services are rendered by participating physicians and providers to an enrolled group of persons is called a(n):

a. joint venture.

b. health maintenance organization (HMO).

c. professional service corporation.

d. Pay for Performance.

b. health maintenance organization (HMO).

The Indian Health Service form of delivering medical care is a form of:

a. Preferred provider organization (PPO)

b. Pay for Performance (P4P)

c. Managed Care

d. Fee-for-service

c. Managed Care

Which term refers to the maximum amount an insurer will pay for a particular medical visit or procedure?

a. capitation

b. fee-for-service

c. co-payment

d. usual and customary

d. usual and customary

Primary care provider responsible for referring members (patients) to specialists

A specified amount of money which a patient A specified amount of money which a patient pays for health care services prior to the insurer making payments

A type of arrangement whereby medical providers are paid for each service performed

Health care services provided by participating medical providers to an enrolled group of persons on a prepaid basis

A provision of managed care in which physicians are rewarded monetarily for improving the quality of their clients' care by reaching specific fixed goals.

A type of insurance which guarantees payment of a specified sum to an employer in the event of financial loss caused by the employee (e.g. theft )

Business management model whereby the business is owned by a single individual

Cost sharing arrangement whereby a specific amount of money is paid by patient to provider each time a service is rendered.  It is usually a set amount or percent of the total cost in which the insurance company pays the remainder.

Type of business management model in which three or more individuals organize to provide services and share the same equipment and personnel.

Type of business model which is organized as a corporation in which licensed individuals render a professional service to the public