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HSM 420 Midterm Exam




HSM 420 Midterm Exam;1. (TCO 1) Why were the first proto-HMOs formed in America? What were the original driving factors in the HMO movement? (Points: 20);2. (TCO 1) What is meant by indemnity coverage, and how does it change in managed indemnity? (Points: 20);3. (TCO 2) What is the role of the executive director in a managed care organization? Could you see yourself practicing in this position at some point in your career? Why or why not? (Points: 20);4. (TCO 2) What is the role of the Peer Review Committee in a managed care organization? And why is this function so crucial? (Points: 20);5. (TCO 3) Describe the calculation of capitated payments. How are these rates determined in managed care organizations? (Points: 20);6. (TCO 3) Describe the use of evidence-based clinical criteria in managed care. Why is this process so important in managed care today? (Points: 20);7. (TCO 4) What is meant by pattern review under managed care? Why do payers conduct pattern review, and what kinds of things might they identify during such reviews? (Points: 20);8. (TCO 4) Discuss some key general aspects of physician practice behavior? Include implicit messages from training, and also environmental factors, in your answer. (Points: 20);9. (TCO 7) What is the purpose of hold-harmless and balance-billing clauses in managed care contracts? (Points: 20);10. (TCO 7) What is typically covered under ?term, suspension, and termination? of a managed care contract? (Points: 20)


Paper#74166 | Written in 18-Jul-2015

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