which of the following statements describes managed care?

Utilitarian theory is the sole basis for U.S. health care financing, forming the foundation of Medicare, Medicaid, and privately purchased health care insurance. 51) Which of the following statements about managed care plans is (are) true? d. Network model Triple option plan. (The catastrophic limit is usually higher than those common in other plans.) B) Employers, insurance companies, and other health insurance benefit providers are typical groups that contract with PPOs. fee-for-service. Also called independent practice association (IPA) HMO, contracted health services are delivered to subscribers by physicians who remain in their independent office settings. Which of the following is NOT relevant to the care of animals in floods? A) The contribution rate is fixed. Local plans allow communities to integrate with state and federal response to disasters. b. EJEMPLO: Es probable que nosotros evitemos una tempestad. The administration of managed care includes: is responsible for the health of a group of enrollees and can be a health plan, hospital, physician group, or health system. 2.1) Which of the following best describes the form of medical practice management in which the provider's personal property is attached and may be sold if the business fails? a. Point-of-service plan (POS) Patient care delivery 2. b. 2.7) How many years of a residency program is required for newly graduated M.D.s choosing to specialize in family practice, internal medicine, or pediatrics? C) education and income. I. yo poner sus cosas debajo del asiento which of the following statements describes managed care? C. Do not tie animals to unhitched trailers, as many animals are strong enough to pull the trailer away. is a private, not-for-profit organization that assesses the quality of managed care plans in the United States and releases the data to the public for consideration when selecting a managed care plan. Class 1: ACE inhibitors, ARB's, CCB's, and Be, Byron Almen, Dorothy Payne, Stefan Kostka, Eric Hinderaker, James A. Henretta, Rebecca Edwards, Robert O. Self, John Lund, Paul S. Vickery, P. Scott Corbett, Todd Pfannestiel, Volker Janssen, Ch 5 Ethical Quandaries in Community Health N. A primary care provider (PCP) assigned to each subscriber is responsible for coordinating health care services and referring subscribers to other health care providers. 17. The _______ is responsible for supervising and coordinating health care services for enrollees and approves referrals to specialists and inpatient hospital admissions (except in emergencies). These include provider networks, provider oversight, prescription drug tiers, and more. 19694 A) The insurance company pays all or most of the costs. "Sign up for childbirth classes." c. "Sign up for the WIC program." d. "Take your prenatal vitamins daily." A A POS plan is not an HMO, but it is a managed care plan that combines the characteristics of an HMO and a preferred provider organization (PPO) (discussed below). Which of the following statements arecorrectregarding injuries and damages that result from earthquakes? A ) . 14. Which of the following phrases is characteristic of case management as a method of healthcare delivery? I. c. managed care plans because of restrictions placed upon their freedom to treat patients. A) care of acute illnesses C) health promotion B) care of chronic illnesses D) health restoration. Beginning in 2006, the Physician Quality Reporting System (formerly called Physician Quality Reporting Initiative or PQRI system) established a _____ incentive for eligible professionals who participate in a ________ quality reporting program. Select all that apply. 2.16) Twenty-five percent of urgent care patients do not have which of the following? e. Although you will first check with her provider, you are sure she is to see which of the following? In outbreaks reported from acute care settings in the U.S. following implementation of unive. He tells the nurse, "I don't know what that word, outpatient, means." Managed care plan enrollees receive care from a ________ selected from a list of participating providers. B. Composting is no longer used to dispose of any livestockcarcasses. 1. es mejor todo el mundo tomar su asiento en seguida The appropriateness, efficiency, and medical necessity of health care provided to patients is reviewed on a prospective and retrospective basis. Utilitarian theories Select all that apply. The Healthcare Effectiveness Data and Information Set (HEDIS), sponsored by the National Committee for Quality Assurance, consists of performance measures used to evaluate managed care plans (e.g., rate of Pap smears performed among women of a certain age). 3. Storing patient care information: All of the primary purposes of the health record are associated directly with the provision of patient care services. B. A) The contribution rate is. A. Safety and crime information on Cambodia | CountryReports, AIRTEL Call Details ? CDHPS have become a popular alternative to the increased costs of traditional health insurance premiums and the limitations associated with managed care plans. b. Select one: a.Health insurance must be compulsory for the lower-income two thirds of the population and payments must be proportional to income. 17. B. Livestock agricultures reliance on machines and technology has increased the need for evacuation procedures. 5. U.S. Treasury Department and Internal Revenue Service issued tax guidance information for HRAS in 2002. All parties should foster an ethical environment for the delivery of effective and efficient quality health care. Integrated delivery system (IDS) C. The number of animals that need to be evacuated from a farm is an important factor in determining how quickly a farm can be evacuated. The attachment of preauthorization documentation to health insurance claims submitted to some MCOS. A. In contrast, traditional health insurance coverage is usually provided on a fee-for- service basis in which reimbursement increases if the health care service fees increase, if multiple units of service are provided, or if more expensive services are provided instead of less expensive ones (e.g., brand-name versus generic prescription medication). 2.18) In 2007, how much of the world's population relied on alternative medicine? es dudoso los nios obedecer la seal de abrocharse el cinturn de seguridad universal health insurance. E) The managed care system may required approval for specialty care. Some managed care organizations have discontinued __________ and have adopted ___________ payment plans. Up-to-date lists of patient copayments and fees for each managed care plan contract Special patient interviews to ensure preauthorization and to explain out-of-network requirements if the patient is self-referring 2.19) Who best knows the patient's body and financial situation? A person receiving healthcare insurance from his employer knows that he should check the approved list of contracted healthcare providers before seeking services in order to receive them at a lower cost. Prior to scheduling elective surgery, managed care plans often require a _______; that is, a second physician is asked to evaluate the necessity of surgery and recommend the most economical, appropriate facility in which to perform the surgery (e.g., outpatient clinic doctor's office versus inpatient hospitalization). 27. Ice dams on roofs and large icicles are uncommon causes of building collapse. C) The nurse is considered the "gatekeeper" in the managed care system. What type of agency is this? June 29, 2022. C. The disposal ofcarcassesmust require the permission of the State or Federal Environmental Protection Agency and Department of Natural Resources. Answer: b. B) The contribution rate is fixed, and the retirement benefit is known in advance. Patient care . retire without receiving actuarially reduced benefits. Three patients arrive at the free clinic in need of the same medication, but there is only enough in stock for one person. II. D. All of the above. Answer the following question choosing the stem-changing verb that makes the most sense in the sentence. Unlike traditional fee-for-service. Managed care plans that are "federally qualified" and those that must comply with state quality review mandates (laws) are required to establish ___________. The use of an out-of-area contact can be an effective way to coordinate in disasters. Faculty of English Commerce Ain Shams University, Ajman University of Science and Technology Ajman), BSBLDR403 Lead team effectiveness Assessment 2.docx, SELECT CURTIME SELECT CURTIME 0 HOUR time Returns the hour for time This code, 32 Extraction of data Data extraction improves strategies for incorporating, It is convenient to subdivide the receiver into two parts the demodulator and, The_Impact_of_Financial_Structure__Financial_Leverage_and_Profitability_on_Industrial_Companies_Shar, designates subordinate commanders to serve as joint functional component, Tutorial 5-Midterm RUBRIC-Feb 27[3643].pdf, existence of this power to increase sentences since legislation now provides for, 534 Consultation Status after Flare up The study also collected data on whether, private station rather than have had the glories of command If indeed such, through-the-cognitive-functions-lens-a-socio-technical-analysis.pdf, Which of the following statements about life insurance cash values is (are) true? A. Under the auspices of its Health Care Reform Program, established in July 1993, The Commonwealth Fund is focusing on the need to expand knowledge about managed care organizations. 6. Which of the following correctly describes the role of the USDA in disasters? To create flexibility in managed care plans, some HMOS and preferred provider organizations have implemented a _______, under which patients have freedom to use the managed care panel of providers or to self-refer to out-of-network providers. The cash value of a policy, Which of the following is a regulatory approach to solving information problems in insurance markets? B. Individual Practice Association (IPA) HMO Network Model HMO. The report card contains data regarding a managed care plan's quality, utilization, customer satisfaction, administrative effectiveness, financial stability, and cost control. Step-by-step explanation C. New animal arrivals to a farm should be placed in quarantine until a suitable time has lapsed to rule out the introduction ofcontagious disease. Health plans also use HEDIS results themselves to see where they need to focus their improvement efforts. Usually, all ambulatory services are provided within HMO corporate buildings. horse hind leg tendon sheath. Institutions (singular: institution) are humanly devised structures of rules and norms that shape and constrain individual behavior. Which of the following statements will NOT reduce risks arising from wildfires? c. Medicare established the __________ to ensure the accountability of managed care plans in terms of objective, measurable standards (requirements). 3. B) epidemiology. C. If escaped livestock ingest toxic plants, their milk is likely to still be suitable for human consumption. E) In the past, healthcare focused primarily on prevention of illnesses since it was covered by insurance. a and b only. 5) Which of the following statements describes a defined. Because a ________ would have the practical effect of prohibiting a physician from giving a patient the full range of advice and counsel that is clinically appropriate, it would result in the managed care plan not providing all covered Medicare services to its enrollees, in violation of the managed care plan's responsibilities. Place large and heavy objects on lower shelves and securely fasten shelves taller than 5 feet to walls. A. Indemnity payments to farmers for crop losses that are covered by insurance are managed by the USDA Risk Management Agency. B. D) There is only one supplier for all units of a particular product. Direct contract model A. B. [The work functions are Ta (6.811019J)\left(6.81 \times 10^{-19} \mathrm{~J}\right)(6.811019J), Ba(4.301019J)\mathrm{Ba}\left(4.30 \times 10^{-19} \mathrm{~J}\right)Ba(4.301019J), and W (7.161019J)\left(7.16 \times 10^{-19} \mathrm{~J}\right)(7.161019J); work function is explained . d. C. The Department of Health and Human Services (DHHS) is responsible for overseeing the safety of the environment in the U.S. Select all that apply. An outbreak of a Foreign Animal Disease in the U.S. would likely require the disposal of large numbers ofcarcasses. Which of the following statements accurately describe an aspect of managed care? The National Committee for Quality Assurance (NCQA) evaluates managed care organizations. Never tie an animal up if floods are pending. Providers are employees of the organization. 1) All of the following statements about tax implications of qualified pension plans are correct EXCEPT, A) Investment earnings on plan assets accumulate on a tax. Explain whether or not scientific methods are sets of procedures that scientists follow. A) cost containment C) healthcare rationing B) fragmentation of care D) knowledgeable consumers, 21. Contracted health care services are provided to subscribers by two or more physician multispecialty group practices. C. Pre-existing economic difficulties can exacerbate the impact of disasters on livestock farmers. A managed care organization (MCO) is responsible for the health of its enrollees, which can be administered by the MCO that serves as a health plan or contracts with a hospital, physician group, or health system. Emergency Operations Plans work best within organizational structures responsive to non-emergency duties that are similar to the duties needed in disasters. Copayments range from $1 to $35 per visit, and some services are exempt because coinsurance payments are required instead. A) decreasing diversity C) uneducated consumers B) lower costs of healthcare D) current nursing shortage, 22. What type of insurance is most likely involved? The following are examples of hospital joint ventures that are unlikely to raise significant antitrust concerns. establishes a contract that allows physicians to maintain their own offices and share services (e.g., appointment scheduling and billing). These range from structured staff model HMOS to less structured preferred provider organizations (PPOS). Which of the following describes one of the elements that the nurse practitioner has successfully met? Which of the following statements is correct regarding disasters? Hint and warning: Do not use lower limits on your integrals 1n2n3+1\sum_{1}^{\infty} \frac{n^{2}}{n^{3}+1}1n3+1n2. The local Department ofAnimal Controlis the legal entity in most communities to deal with abandoned and lost animals. C. One of the purposes of an Emergency Operations Plan is to provide anoverviewof the communitys jurisdiction. A. Costs from animal disease outbreaks include loss of production andreplacementof animals. The nurse may make a referral to what member of the healthcare team? D) Pension benefits attributable to the employer, s contributions are not taxed until the employee retires or, 2) Beta Corporation has 1,000 employees eligible to participate in the firm, employees are considered highly compensated. D. Animals will frequently resist walking through flowing water. C) Reimbursement is usually based on fee-for-service. Most PPOS are open-ended plans allowing patients to use non-PPO providers in exchange for larger out-of-pocket expenses. Metal A emits electrons in response to visible light; metals B\mathrm{B}B and C\mathrm{C}C require UV light. D. Landslides rarely affect agricultural property. Each provider is paid a fixed amount per month to provide only the care that an individual needs from that provider (sub-capitation payment). Healthcare Effectiveness Data and Information Set (HEDIS). Proper watershed, forest, and rangeland management is effective mitigation against droughts. B. b. D. Sustained winds of more than 20 mph and hail greater than or equal to 2 inches in diameter are characteristic of severe thunderstorms. B. (a) CO\mathrm{CO}CO, (b) O2\mathrm{O}_2O2, (c) H2S\mathrm{H}_2 \mathrm{~S}H2S, (d) SiH4\mathrm{SiH}_4SiH4, and (e) CHCl3\mathrm{CHCl}_3CHCl3. C. Disasters are declared starting at the local, then state, then federal level. 9 ways Android and Windows 10 can work well together, We asked a leading cosmetic doctor for his top anti-ageing tips. a. information disclosure regulation b. establishing minimum standards and monitoring compliance, The Smallville Mall has assumed the responsibility for payment of liability losses caused by Chuck's Famous Pizza to attract the pizza chain to the mall. B) Payment for services is integrated with delivery of services. B. Biosecurity is the principal method to mitigate (prevent, reduce) disease outbreaks. HSA stands for health savings account, and HSA-qualified plans can be HMOs, PPOs, EPOs, or POS plans. C. Each responding agency and group should operate independently and separately from the others, in order to cover more ground. D. Small amounts of snow never have devastating effects on a community. Animals that have recently moved from a warmer to a colder climate are at a greater risk of hypothermia than animals that have lived in a colder climate for longer periods. A. Select all that apply. National Committee for Quality Assurance (NCQA). Then, identify the type of clause by writing one of the following abbreviations above it: ADJ for adjective clause, ADV for adverb clause, or N for noun clause. Edge Reading, Writing and Language: Level C, David W. Moore, Deborah Short, Michael W. Smith, Literature and Composition: Reading, Writing,Thinking, Carol Jago, Lawrence Scanlon, Renee H. Shea, Robin Dissin Aufses. Which of the following statements iscorrectregarding heat stress in livestock? B. e. D. Large-scale disasters affecting livestock never have serious implications for State revenues. Which of the following statements iscorrectregarding snow fall? In paragraphs 7 and 8, Krauthammer refers to libertarians and the libertarians markets-for-everything logic. What is a libertarian? Which of the following statements apply to the transportation of livestock? Which of the following statements describes appropriate procedures for dealing withanimal health/disease? c. which of the following statements describes managed care? Accreditation organizations, such as the NCQA, evaluate MCOS according to preestablished standards. B. Note In managed care, the primary care provider usually receives capitation payment and is responsible for managing all of an individual's health care, which includes reimbursing other caregivers (e.g., specialists). Then, identify each adjective clause as essential (E) or nonessential (N). Funds in an FSA are exempt from both income tax and Social Security tax (employers may also contribute to FSAS). 26. Federal agencies are usually activated directly in response to requests from local emergency managers. D. All of the above. D. The USDA responds to disasters that threaten national food production, processing and distribution. D. All suspect findings of Foreign Animal Diseases have to be reported to State or Federal veterinarians. (Network providers are usually reimbursed on a fee-for-service basis. Smallville Mall's insurer knows the existence, Insurable interest may exist when Select one: a.Julia has insurance on a car she just sold, b.Wells Fargo bank lends Tien $300,000 to buy a house and buys insurance on the house, c.Anthony, a, Assume that the following probability distribution exists for automobile damages. HMOS often require a copayment (or copay), which is a fee paid by the patient to the provider at the time health care services are rendered. C. Intensification of U.S. dairy production has manifested itself as lower productivity of individual cows. C. Only if flowing water is above your waist is it too high to cross. Health risk assessment instruments (surveys) and resources are also available to subscribers. Individuals have greater freedom in spending health care dollars, up to a designated amount, and receive full coverage for in-network preventive care. a. proximal radius e. A. managed care. which of the following statements describes managed care? Citizens discuss the ideal of equal access to health care for everyone, including care for indigents. 6. Providers are employees of the organization. e. Staff model Who would be most likely to teach the classes? which of the following statements describes managed care? A. Floodwaters are frequently contaminated with hazardous chemicals. Relationships are not critical in the delivery of health services. Crop insurance to protect against the effects of summer storms. Health care services are provided to subscribers by physicians employed by the HMO. A Colles fracture occurs at the: Tax-exempt account that is used to pay for health care expenses. The marketing department is launching a new advertising campaign. C. Annual property loss resulting from thunderstorms, including damage to farms and barns, is estimated in the hundreds of millions of dollars. A) Medicaid C) health maintenance organization B) preferred provider organization D) long-term care insurance, 18. All of the highly compensated employees are covered by the, plan. Which of the following statements correctly describe liability issues in disasters? Which of the following accurately describes relationship between disasters and the economic impact on livestock farmers? You have three metal samples- A,B\mathrm{A}, \mathrm{B}A,B, and C\mathrm{C}C - that are tantalum (Ta), barium (Ba), and tungsten (W), but you don't know which is which. Out-of-pocket payments for health care expenses, which are made after the tax-exempt account is expended and before the deductible for high-deductible insurance has been met; this tier actually represents a gap in coverage b. a condition in which the nasal septum strays from the midline of the nasal cavity, c. a chronic bacillus infection that usually affects the lung and is caused by a mycobacterium, d. an inflammation of the mucous lining of the larynx, e. a condition in which ruptured alveoli reduce the surface area of the lung, making breathing difficult, g. an obstructive disorder characterized by recurring spasms of the smooth muscles of the bronchi, i. an inflammation or infection of the pharynx, j. a disease characterized by a lack of surfactant in the alveoli; usually occurs in premature infants. Plans are required to meet minimum performance levels and to show demonstrable and measurable improvement in specified broad clinical areas (e.g., preventive services, acute ambulatory care, chronic care, and hospital care) based on performance improvement projects that each plan identifies. Which of the following statements correctly describes the role of the Federal Emergency Management Agency (FEMA) in disasters? I. Why is livestock agriculture thought to be more vulnerable to disasters now than in 1900? d. distals carpals, Use the integral test to find whether the following series converge or diverge. B) Risk management is concerned with reducing exposure to legal liability. Participants enroll in a relatively inexpensive high- deductible insurance plan, and a tax-deductible savings account is opened to cover current and future medical expenses. c. 2.6) Which of the following best describes the alternative medicine modality of homeopathy? Never tie an animal up if floods are pending. The National Committee for Quality Assurance (NCQA) reviews managed care plans and develops report cards to allow health care consumers to make informed decisions when selecting a plan. Answer the following questions about these Canadian artists. In return, individuals assume significantly higher cost-sharing expenses after the designated amount has been expended. D. A good time to check your window shutters and supply of boards, tools, batteries, nonperishable foods, bottled water, and other equipment is during a hurricane watch. Which of the following statements accurately describes disaster assistance? (b) What range of wavelengths would distinguish B\mathrm{B}B and C\mathrm{C}C ? (a) CO2\mathrm{CO}_2CO2, (b) O3\mathrm{O}_3O3, (c) SO3\mathrm{SO}_3SO3, (d) SF6\mathrm{SF}_6SF6, and (e) Al2Cl6\mathrm{Al}_2 \mathrm{Cl}_6Al2Cl6. Escriba lo que dice. Managed care plans implement _______ as a method of controlling health care costs and quality of care. Yet, segments of the health care system maintain aspects of a free-market competition. Additional paperwork for specialists to complete and the filing of treatment and discharge plans The group plan will pay a portion of the employee's expenses B. Libertarian theories Which of the following statements accurately describe an aspect of managed care? Qu haces t? Which of the following best describes the connection between ethics and health care financing? 19. All definitions of institutions generally entail that there is a level of persistence and continuity. c. C. Veterinarians dont know much about the clinical aspects of food animals exposed to hazardous chemicals. perpetual motion ornaments; who plays elias in queen of the south; robert snodgrass net worth; pacific northwest volleyball association; 1 . The nurse in charge of the clinic asks herself, "Who needs this medicine most?" Accreditation is a voluntary process that a health care facility or organization (e.g., hospital or managed care plan) undergoes to demonstrate that it has met standards beyond those required by law. c. a. Patients should be well informed about care and treatment options. A nurse in a walk-in healthcare setting provides technical services, such as, administering medications, determines the priority of care needs, and provides patient teaching on all aspects of care. A. 13. arrangements to alter provider and patient behavior so that health care services are delivered and utilized in a more. 3. The appropriateness, efficiency, and medical necessity of health care provided to patients is reviewed on a prospective and retrospective basis. Health care can be purchased or given freely in Country A, but there is no entitlement program to ensure basic health care to vulnerable people. They are intended to prevent the problem of covering members who are sicker than the general population (called adverse selection). Accreditation of Managed Care Organizations. Nurse case managers coordinate patient care from the time of hospital admission to the time of discharge and often following discharge from an . 29. ayudar a los otros pasajeros Which of the following ethical theories place the community, rather than the individual, the state, the nation, or any other entity, at the center of the value system? Some case managers employed by the MCO to monitor services provided to enrollees and to be notified if a patient fails to keep a preauthorized appointment View the full answer. If enrollees choose to receive all medical care from the managed network of health care providers, or obtain an authorization from their POS primary care provider for specialty care with an out-of-network provider, they pay only the regular copayment or a small charge for the visit and they pay no deductible or coinsurance costs. Which one of the following statements best describes the family caregiver burdens of providing home care ? 15. 2.15) Which of the following allied health professionals practice medicine under the direction and responsible supervision of providers and surgeons? Utilization management activities include: preadmission certification (PAC) or preadmission review, preauthorization, concurrent review, and discharge planning. Correctly identify disorders of the wrist. It is a system that is based on patient and provider autonomy. . B. Mitigation of transportation accidents involves the use of properly designed trailers and regular trailer maintenance. It attempts to control costs by modifying the behavior of providers and patients. a) managed care. How would the nurse respond? d. Despite this, the country has significantly worse healthcare outcomes when compared to peer nations. The physician group can be owned or managed by the HMO, or it can simply contract with the HMO. A) Managed care systems control the cost of care with a lower quality of care. Disaster advice from the USDA is provided by the Cooperative Extension Service. These organizations must take care to use their resources in support of a charitable purpose.Start a Nonprofit Organization in Ohio 3 Pursuant to Ohio Revised Code Section 1745.51, if a statement of an unincorporated nonprofit association is on file with the Secretary of State, then upon adopting a voluntary resolution of dissolution, a copy of . Exclusive provider organization (EPO) Some managed care plans contract out utilization management services to a _________ an entity that establishes a utilization management program and performs external utilization review services. B. D. For a State to qualify for Federal disaster assistance from FEMA, it is best if the State has laws that are consistent with those of Federal emergency management law. The aftermath was first by the Bush administration - by George Bush's then secretary of Treasury, who had come right from Goldman Sachs, which was Hank Paulson. Most managed care financing is achieved through a method called capitation, and enrollees are assigned to or select a primary care provider who serves as the patient's gatekeeper. Unused balances "roll over" from year to year; if an employee changes jobs, he or she can continue to use the HSA to pay for qualified health care expenses. 92) Which of the following best describes vendor managed inventory? Healthcare in the United States is far outspent than any other nation, measured both in per capita spending and as a percentage of GDP.