______Within a Single Product Firm or a Division of a Larger

question 16

Multiple Choice

______within a single product firm or a division of a larger firm must be integrated.

• A) Centralized departments
• B) Decentralized departments
• C) Functional departments
• D) all of the above
• E) none of the above

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Definitions:

Insurance Policy

A contract between an insurer and a policyholder that provides compensation for specified losses in exchange for premiums paid.

Capitation

The health care provider is paid a fixed amount per member per month for each patient who is a member of a particular insurance organization regardless of whether services were provided.

Precertification

Refers to obtaining plan approval for services prior to the patient receiving them; refers to seeking approval for a treatment (surgery, hospitalization, diagnostic test) under the patient’s insurance contract.

Specified Outpatient

Specified Outpatient refers to particular outpatient medical treatments or procedures that are predefined under a health plan or policy for coverage or reimbursement.