Define the following.
1. Medicare
2. Medicaid
3. Employer coalition
4. HEDIS
5. Federal Trade Commission
6. Kick-back
7. ERISA
8. McCarren-Ferguson Act of 1945
9. Anti-trust
10. HMO Act of 1973
1. What is the Central Florida Health Care Coalition (what type of _____ coalition)?
2. Why did employers in the U.S. become major sponsors of health care coverage?
3. Who purchases healthcare in the U.S.?
4. What is the role of labor unions in managed care?
5. Describe the Mediciad managed care program.
6. What are some practices and regulations of Medicare managed care?
7. What is “value”?
8. How do purchasers assess plan value?
9. How do MCOs manage utilization during the course of a hospitalization?
10. What are some methods of managing utilization of specialty services?
11. Define utilization management (UM). Does it ever result in denying care?
12. What types of reviews are used in utilization management?
13. What are some red flags indicating the need for case management?
14. Give some examples where case management is not beneficial.
15. What does medical technology assessment include?
16. What is disease management? Give examples.
17. What criteria do MCOs use to authorize or deny medical treatment?
18. What are referral authorizations?
19. What does pre-certification aim to do?
20. Define quality.
21. What are some roles/purposes of quality assurance programs?
22. What are patient satisfaction surveys intended for?
23. What are some sources of data for quality measurement?
24. How can outcomes data be used?
25. Who accredits managed care organizations?
26. Give examples of fraud in health care.
27. Give examples of anti-trust violations in health care.
28. Distinguish between fraudulent acts and those falling under anti-trust violations.