Question Details

HSM 420 Week 4 Mid - Term  
1.	Question :	(TCO 1) How has the relationship between government and managed care evolved over the years? What factors have driven this changing relationship?

 	
Question 2.	Question :	(TCO 1) What is meant by indemnity coverage, and how does it change in managed indemnity?

 	
Question 3.	Question :	(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?

 	

Question 4.	Question :	(TCO 2) What is the role of a denial-of-coverage appeal committee in a managed care organization? And why is this function so crucial?

 	
Question 5.	Question :	(TCO 3) Discuss pay for performance (P4P) in managed care. What are the pros and cons of the P4P approach to compensating providers?



Question 6.	Question :	(TCO 3) What are the six key types of authorizations? Provide a brief description for each type.

 	

Question 7.	Question :	(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?

 	
Question 8.	Question :	(TCO 4) How should managed care organizations address noncompliance by individual physicians? Provide some specific examples of approaches to this problem that may be effective.

 	
Question 9.	Question :	(TCO 7) What is the purpose of hold-harmless and balance-billing clauses in managed care contracts?

 	
Question 10.	Question :	(TCO 7) What is typically covered under “term, suspension, and termination” of a managed care contract?