To achieve widespread use of electronic data interchange (EDI) in the healthcare industry, all entities within the industry need to agree on industry standards regarding the information format and software to be used. Several organizations are making cont
Which of the following is NOT a factor that is used by MCOs to determine which services will undergo utilization review?
The main purpose of the Health Plan Employer Data and Information Set (HEDIS) is to provide
The following statement(s) can correctly be made about the characteristics of reports that should be provided to managers for use in managing a healthcare delivery system:
The scandent Health Group contracted with the Empire Corporation to provide behavioral healthcare services to.
Empire employees. As a condition of providing behavioral healthcare services, scandent required Empire to contract with scandent for basic medical services scandent's actions constituted the type of antitrust violation known as a
Each time a patient visits a provider he has to pay a fixed dollar amount?
To set up and contribute to an HSA, an individual must:
To address the problems associated with multiple data management systems, the Kayak Health Plan has begun to use a data warehouse. One likely characteristic of Kayak's data warehouse is that:
The Robust Health Plan sometimes uses prospective experience rating to calculate the premiums for a group. Under prospective experience rating, Robust most likely will:
Arrange the following provider organizations in the order ranging from least integrated.
I. Physician Practice Management (PPM) company
II. Integrated Delivery System (IDS)
III. Group Practice Without Walls (GPWW)
IV. Independent Practice Association (IPA)
