Answer the following statements true (T) or false (F)
1 All health insurance contracts define medical necessity in the same way.
2) If a physician has ordered surgery for a patient, a managed care organization (MCO) case
manager may disallow an inpatient stay if the MCO guidelines designate the procedure as best
suited for outpatient care.
3) A goal of managed care is for the patient to receive care in the most appropriate and most
restrictive setting.
4) A primary care physician (PCP) in a health maintenance organization (HMO) can be an
OB/GYN.
5) An integrated delivery system (IDS) is a network of healthcare organizations under a parent
holding company.
1. FALSE
2. TRUE
3. FALSE
4. TRUE
5. TRUE
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When is it more appropriate for the physician, rather than another staff member, to make a follow-up call to a patient?
a. The treatment provided was in the emergency room. b. The treatment had complications. c. The complications from a treatment were life threatening. d. The physician never needs to be the one to follow up on patient progress.