The following statements apply to health reimbursement arrangements. Select the answer choice that contains the correct statement.
When determining physicians' fee reimbursements, the Blossom Managed Healthcare Group assigns a weighted value to each medical procedure or service and multiplies the weighted value by a money multiplier, as shown below:
Weighted value for service × Money
Which of the following is an example of physician only model of operational integration?
The existing committees at the Majestic Health Plan, a health plan that is subject to the requirements of HIPAA, include the Executive Committee and the Corporate Compliance Committee. The Executive Committee serves as a long-term advisory body on issues related to overall organizational policy. The Corporate Compliance Committee are convened to address specific management concerns. The following statement(s) can correctly be made about these committees:
Which of the following features differentiates a 'Clinic without walls1 from a consolidated medical group?
The following statements are about the underwriting function within a health plan. Select the answer choice containing the correct statement.
High deductible health plans (HDHP) are characterized by all of the following features except
The contract between an employer and an insurer or other TPA is called
Bill the member for the balance of the fee above the maximum allowable amount under the fee schedule reimbursement method
The health plan determines what it considers to be the acceptable fee for a service or procedure and the physician agrees to accept that amount as payment in full for the procedure
