Briefly describe PPO and HMO plans.
What will be an ideal response?
• The PPO is essentially a fee-for-service type of health plan that allows a beneficiary to choose a physician from a list of participating providers that have agreed to give the purchaser a discount on regular fees. The health plan generally has contracted a discounted rate from participating providers for their services. In return, the providers hope that the members of the health insurance plan will choose them more frequently. Members benefit by choosing a preferred provider because their share of the cost is substantially reduced.
• HMOs contract with a particular group of physicians (primary care physicians [PCPs] and specialists) to take on full responsibility for all health care provided to a list of enrolled patients. The provider group is then paid a fixed fee per patient per month (capitation rate) irrespective of the actual costs incurred. This type of arrangement allows the health plan to limit its financial exposure while providing the physicians with a steady stream of revenue. In addition, the members benefit from the small deductibles and lower copayments associated with these plans.
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A 58-year-old male visits his physician for extreme fatigue. After conducting a standard investigation, the physician strongly suspects that the patient is suffering from CML. Which of the following lab results would confirm this picture?
a. Hypercellular bone marrow b. Hypercellular bone marrow with dysmyelopoiesis c. Positive molecular analysis for BCR/ABL1 d. Increased WBC count
What are the supplementary classifications of the ICD-9-CM known as?
A) Alphabetic Index to Poisonings and Injuries B) Alphabetic Index to Procedures C) External Causes of Diseases and Injuries D) V Codes and E Codes
Frowning, glaring, and smiling are all examples of _________ __________.
Fill in the blank(s) with the appropriate word(s).
Which of the following describes fibrous joints?
A. They are freely moveable. B. They are only slightly moveable. C. They are located between the facial bones and vertebrae. D. They are held together by a fibrous joint capsule.