Reference for the questions below:
Principles of Healthcare Reimbursement
Fifth Edition – Anne B. Casto
Chapter 5 Review Quiz
1. Describe at least three ways in which MCO’s work toward their goal of quality patient care.
2. From where do evidence-based clinical guidelines originate?
3. List at least two reasons that MCO’s survey their members for feedback.
4. Name the three steps in medical necessity and utilization review.
5. Describe three types of cost controls used by MCO’s.
6. Which type of HMO offers patients the least selection in referrals to specialists?
7. List at least five types of cost controls used by MCO’s.
8. True or False? Disease management is closely associated with coordination of care tools of MCO’s
because efforts of multiple providers must be synchronized in disease management.
9. True or False? By definition, integrated delivery systems must directly provide health services to their
members.
10. True or False? Integrated delivery systems, as a result of strict federal regulation, have evolved into a
single common type.
