Transcribed image text: Which of the following is a characteristic of the staff model of an HMO? O a A group of independent physicians contract with an HMO b. Insurance company reimburses beneficiary for out-of-pocket expenses Physicians are employees of the HMO d. Patients may visit any doctor they choose
Answer ; C. Physician are the employees of the HMO. Reason ; Among the given option the best statement the reflect the exact characteristics of the staff model type of HMO is the above mentioned statement. The statement given in the option 'a' is suitable only if the type would be group model. The other two statement are not relevant to the questions.
May 12, 2020 · Indeed, one of the major benefits of working in a staff-model HMO is that your salary is guaranteed and work hours are fairly regular. A practice administrator handles the business aspects of the practice, leaving physicians free to do what they do best, take care of patients. Physicians also find staff-model HMOs convenient for patient care.
11 Characteristics of HMO • Organized health-care plan • Broad, comprehensive health services • Restrictions of choice of physician • Payment of a fixed, prepaid fee • Heavy emphasis on controlling costs 12 Preferred Provider OrganizationA plan that contracts with health care providers to provide medical services to members at reduced fees 13 Characteristics of PPO • …
PPO: Preferred provider organization. Entity that contracts with employers and insurers to render, through a network of providers, healthcare services to a group of members. Members can choose to use the healthcare services of any physician, hospital, or other healthcare provider.
Specialized entity that provides management services and administrative and information systems to one or more physician group practices or small hospitals. An MSO may be owned by a hospital, physician group, physician-hospital organization, integrated delivery system, or investors.
Gatekeeper: Healthcare provider or entity responsible for determining the healthcare services a patient or client may access. The gatekeeper may be a primary care provider, a utilization review or case management agency, or a managed care organization.
Characterized by 1) arrangements with specific providers to deliver a comprehensive set of healthcare services 2) criteria for selecting providers 3) quality assessment and utilization review and 4) incentives for members to use plan providers. AKA Coordinated Care Organization.
Preadmission certification: Process of obtaining approval from a healthcare insurance company before receiving healthcare services (AKA pre-certification). Preadmission review:
Family and general practitioners, internists, pediatricians, and OBGYNs are primary care physicians. Primary care provider = Healthcare provider who provides, supervises, and coordinates the healthcare of a member. The PCP makes referrals to specialists and for advanced diagnostic testing.
Method of payment for health services in which an individual or institutional provider is paid a FIXED, per capita (per person) amount for EACH PERSON enrolled WITHOUT regard to the actual number or nature of services provided or number of persons served