NWCA STUDY GUIDE WITH COMPLETE
SOLUTIONS
Managed Care Organization (MCO) - Correct Answers -Combines functions of health
insurance, delivery of care and administration
Exclusive Provider Organization (EPO) - Correct Answers -Services covered only if use
doctors, specialists or hospitals in plans network (except in hospitals)
Health Maintenance Organization (HMO) - Correct Answers -Limits coverage to care
from doctors who work for or contract with the HMO, generally won't cover out of
network care except in emergency. May require to live or work in its service area.
Point of Service (POS) - Correct Answers -Pay less if you use doctors, and other health
care providers that belong to the plans network, required to get a referral from primary
care doctor in order to see specialist
Quality Improvement Organization (QIO) - Correct Answers -Physician can hose
whether or not accept Medicare patients, who are seeking non medical services, signs
an agreement and May sign a participating provider agreement(PAR)
Preferred Provider Organization (PPO) - Correct Answers -Pay less if use providers in
plans network. Can use providers outside of network without a referral for N additional
cost.
DHHS stands for - Correct Answers -Department of health and human services
Coding systems for Medicare Part B Services - Correct Answers -CPT ( procedure or
service), HCPCS( procedure, service, or durable medical equipment), ICD-10
(diagnosis)
PART C is - Correct Answers -Medicare + choice program, some options include hmo,
pos, PPO, msa
Part D - Correct Answers -Prescription drug coverage started in 2006
Medicare Administrative Contractor (MAC) is - Correct Answers -A private health care
insurer awarded geographic jurisdiction to process medicare A y B
Medicare A covers - Correct Answers -Hospital care, skilled nursing facility care,
nursing home, ( as long as custodial care isn't the only type of care needed), hospice, o
e health services
