Question

18 multiple choice 1 point health maintenance organizations can: refuse benefit coverage to patients if they determine retrospectively that a patients condition did not require emergency department care. refuse benefit coverage to patients if they determine retrospectively that a patients condition did not require emergency department care, thus placing the burden on the provider to seek reimbursement from the patient if the insurer does decide to cover the charges. refuse benefit coverage to patients if they determine retrospectively that a patients condition did not require emergency department care even though federal law prohibits hospital emergency departments from turning away patients seeking emergency care. not refuse benefit coverage to patients if they determine retrospectively that a patients condition did not require emergency department care. 19 multiple choice 1 point ____ is an increasingly important aspect of utilization management that involves identifying at an early stage those patients who could be treated more cost - effectively in an alternative setting or at a lower level of care without negatively affecting the quality of care. prospective review case management financial review lab review 20 multiple choice 1 point whenever a managed care organization possesses significant market share, corporate liability is likely to occur. malpractice is likely. poor care results. antitrust implications can arise.

Explanation:

1. Health maintenance organizations can refuse benefit coverage if they determine a patient's condition didn't require emergency - department care, even with federal law protecting patients from being turned away at emergency departments.
2. Prospective review is about identifying early patients who can be treated more cost - effectively in alternative settings without sacrificing care quality.
3. When a managed care organization has a large market share, antitrust implications can arise due to potential monopolistic behavior.

Answer:

1. refuse benefit coverage to patients if they determine retrospectively that a patient's condition did not require emergency department care even though federal law prohibits hospital emergency departments from turning away patients seeking emergency care.
2. Prospective review
3. antitrust implications can arise.