QUESTION 16

Prospective Utilization Management includes demand management, referral management and precertification of institutional services. TRUE or FALSE

True

False

2 points (Extra Credit)

QUESTION 17

Pay-for-performance, in which at least some portion of financial incentives is aligned with the practice of evidence-based clinical care, continues to grow.

True

False

4 points

QUESTION 18

The MCO negotiates a single per diem rate of payment per ______ in the hospital.

	a.	Case rate
	b.	Capitation
	c.	Charges
	d.	Day

4 points

QUESTION 19

Disease management is a special form of case management in which the MCO focuses on a handful of selected diseases and works proactively with each patient to control the diseases course.

True

False

4 points

QUESTION 20

A carve-out refers to :

	a.	A set of medical services that are taken out of the basic arrangement.
	b.	A set of licenses required by an HMO
	c.	A set process of obtaining and reviewing plan benefits by an outside agency
	d.	A set amount of money a taken out prior to coverage verification