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Healthcare Management: An Introduction Questions 166–170 (page: 35)

Specialty services with certain characteristics tend to make good candidates for health plan approaches. One characteristic used to identify a specialty service that may be a good candidate for a health plan approach is that the service should have

The prudent layperson standard described in the Balanced Budget Act (BBA) of 1997 requires all hospitals that receive Medicare or Medicaid reimbursement to screen and, if necessary, stabilize all patients who come to their emergency departments.

The Acme HMO recruits and contracts directly with a wide range of physicians--both PCPs and specialists--in its geographic area on a non-exclusive basis. There is no separate legal entity that represents and negotiates the contracts for the physicians. The

The administrative simplification standards described under Title II of HIPAA include privacy standards to control the use and disclosure of health information. In general, these privacy standards prohibit

The Advantage Health Plan recently added the following features to its member services program:
IVR
Active member outreach program
Advantage's member services staffing needs are likely to increase as a result of