Under managed care, the contract for independent multispecialty medical providers includes significant financial incentives for the physicians to provide proper patient care and financial management.
Answer the following statement true (T) or false (F)
True
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In the Gatekeeper PPO scenario, the member chooses a family provider or physician and must see him or her before being referred to a specialist
Indicate whether this statement is true or false.
Placing a caller on hold is ________ when you are speaking with a caller on one line and another call comes in.
A. unacceptable B. regrettable C. permissible D. punishable
What is the national correct coding initiative?
A. a set of guidelines developed in 1996 intended to reduce incorrect coding and improper overpayments or underpayments through the identification of codes that may or may not be utilized together or that are medically unlikely B. A qualified healthcare professional who is not a physician but who is authorized to practice medicine, is licensed and registered with the state in which he or she practices medicine, and is authorized to prescribe controlled substances during the management and treatment of a patient; also called a midlevel practitioner C. A 38-chapter compendium of guidelines for reporting healthcare claims; maintained and updated by CMS D. a national organization composed of multidisciplinary volunteers dedicated to providing authoritative guidance on the standards for content and data for noninstitutional healthcare claims; maintains and updates the CMS-1500 claim form
What was the purpose of the Orphan Drug Act?
To create classifications of prescriptions To ensure that all drugs are safe and effective To allow drug manufacturers the ability to bypass lengthy testing to treat patients with rare diseases To create standards for child-resistant packaging