#1
What is the primary goal of managed care in healthcare?
To maximize profits for healthcare providers
To improve quality of care while controlling costs
To limit patient access to healthcare services
To prioritize speed of treatment over cost
#2
Which of the following is a key feature of a Health Maintenance Organization (HMO)?
Freedom to choose any healthcare provider
Reimbursement based on fee-for-service
Requirement of referrals for specialists
Direct payment to healthcare providers
#3
Which of the following is a potential disadvantage of managed care for patients?
Limited choice of healthcare providers
Lower quality of care compared to fee-for-service
Higher out-of-pocket costs
Difficulty in obtaining referrals
#4
Which of the following is a characteristic of a Preferred Provider Organization (PPO)?
Requirement of referrals for specialists
Reimbursement based on capitation
Limited choice of healthcare providers
Ability to see out-of-network providers at a higher cost
#5
What is a characteristic feature of a Point of Service (POS) plan?
Limited choice of healthcare providers
Freedom to see out-of-network providers without penalty
Requirement of referrals for specialists
Reimbursement based on fee-for-service
#6
Which of the following is NOT a characteristic of managed care organizations (MCOs)?
Emphasis on preventive care
Use of capitation as a payment model
Unrestricted access to any healthcare provider
Utilization management techniques
#7
In managed care, what does the term 'gatekeeper' refer to?
The primary care physician who coordinates a patient's care and referrals
The insurance company responsible for approving treatment plans
The government agency overseeing managed care regulations
The hospital administrator in charge of admissions
#8
Which act played a significant role in the expansion of managed care in the United States?
Medicare Act of 1965
Affordable Care Act (ACA) of 2010
Health Maintenance Organization Act of 1973
Social Security Act of 1935
#9
What is the role of a pharmacy benefit manager (PBM) in managed care?
To provide direct patient care in pharmacies
To negotiate drug prices with pharmaceutical companies
To manage the financial aspects of healthcare services
To oversee medical billing processes
#10
What is adverse selection in the context of managed care?
The tendency for healthier individuals to enroll in managed care plans
The process of denying coverage to high-risk patients
The practice of overutilization of healthcare services
The requirement of preauthorization for medical procedures
#11
What is the main principle behind utilization management in managed care?
To minimize the use of healthcare services
To ensure patients receive appropriate care at the right time and cost
To maximize profits for healthcare providers
To limit access to specialist care
#12
What is the primary objective of disease management programs in managed care?
To reduce the prevalence of diseases in the population
To control healthcare costs related to chronic conditions
To restrict access to specialized treatments
To increase profits for healthcare providers
#13
What is the primary focus of managed care accreditation organizations?
Ensuring profitability of managed care plans
Evaluating compliance with healthcare regulations
Providing direct patient care services
Negotiating contracts with healthcare providers
#14
What is the primary focus of a Health Information Management (HIM) department in a managed care organization?
Managing patient appointments
Ensuring data security and integrity of medical records
Providing direct patient care
Negotiating contracts with healthcare providers
#15
What is a common method used by managed care organizations to control healthcare costs?
Encouraging unnecessary medical procedures
Providing unlimited coverage for all services
Utilizing prior authorization for certain treatments
Offering premium discounts to high-risk patients