Deck 11: Managed Care and Third-Party Reimbursement

Question 1

In 1883, _____________ became the first nation to legislate national health insurance.

A) England
B) France
C) Canada
D) Germany

Answer 1

Germany

Question 2

Increased coverage of mental health services by insurance companies occurred as a consequence of:

A) passage of the Community Mental Health Centers Act of 1963
B) increased acceptance of counseling
C) decreased stigmatization of the consumers of mental health services
D) all of the above

Answer 2

all of the above

Question 3

Which of the following underlying assumptions were critical in the move toward managed care in the United States?

A) The doctor knows best.
B) We must spend whatever is necessary to assist persons in covering their health costs.
C) Steps must be taken to control the upward spiral of medical/mental health costs to employers and insurers.
D) (a) and (b)

Answer 3

Steps must be taken to control the upward spiral of medical/mental health costs to employers and insurers.

Question 4

By the early 1990s, the costs of health care were increasing at a rate of __________ the rate of inflation.

A) equal to
B) double
C) three times
D) ten times

Question 5

The findings of Vessey and Howard (1993) confirmed to insurance providers that as many as _________ of persons being seen for psychotherapy did not meet the DSM diagnostic criteria of the disorder for which they were being treated.

A) 10%
B) 25%
C) 40%
D) 50%*

Question 6

By multiplying utilization of a mental health service by the cost per unit, the ____________ is calculated.

A) employer expenditure for health care benefits
B) total health care costs
C) frequency of mental health care usage
D) net income of agency mental health professionals

Question 7

Managed care commonly refers to a range of programs that:

A) control access to health care
B) set limits on the types of health care delivered
C) control the cost of specific health care services
D) all of the above

Question 8

Which of the following mechanisms are used by managed care organizations to contain healthcare costs?

A) pretreatment authorization of service
B) utilization reviews
C) increased employer/ user cost sharing
D) all of the above

Question 9

Which of the following is not true regarding the pretreatment authorization of treatment?

A) clients typically can obtain any number of sessions they seek for the treatment of their presenting condition.
B) any treatment authorized must be determined to be medically necessary.
C) the frequency and quantity of session must be appropriate for the severity of the condition being treated
D) counselors risk not being reimbursed for services rendered if it has not received authorization.

Question 10

The answer to the question, "To what extent is it necessary for the client to continue in treatment beyond the number of sessions initially authorized" is determined through:

A) pretreatment authorization.
B) concurrent utilization reviews.
C) application of GAF scale ratings.
D) formative program evaluation.

Question 11

Which of the following must be demonstrated in order for a mental health professionals to be placed on a provider panel?

A) It must be demonstrated that there is a need for additional panel participants in a given geographic region.
B) The mental health professional must demonstrate that they follow acceptable diagnosis and treatment procedures.
C) The mental health provider must be willing to accept reduced fees for service rendered.
D) all of the above
E) (a) and (b) only

Question 12

Which of the following is not a way of controlling the cost per unit of mental health service?

A) pretreatment authorization of treatment
B) capitation
C) using less expensive but equally effective treatments
D) all of the above

Question 13

It is quite likely that mental health care providers will see a return of a "fee-for-service" structure due to the inefficient bureaucracy created by managed care organizations.

Question 14

Which of the following professions has most likely benefited from managed care's trend to utilize less expensive, but equally treatment approaches?

A) psychiatry
B) clinical psychology
C) counseling psychology
D) master's-level mental health counselors and social workers

Question 15

Mental health practitioners are reimbursed at a fixed rate per regional member of a managed care organization, regardless of quantity or types of sessions conducted under a _____________ framework.

A) fee-for-service
B) behavioral health
C) capitation
D) pretreatment authorization

Question 16

According to Beier and Young (1998), how have mental health professionals responded to managed care?

A) moving toward and embracing managed care
B) moving away from and not collecting third-party reimbursement for services
C) moving against managed care by resisting and occasionally taking managed care organizations to court
D) all of the above

Question 17

Health maintenance organizations are the most common form of managed care systems.

Question 18

Under capitation, the more clients a counselor sees results in an increase in income.

Question 19

Which type of managed care system consists of a network of providers that collectively provide comprehensive health care coverage or an array of speciality care?

A) Health maintenance organizations
B) Preferred provider organizations
C) Service plans

Question 20

Which procedure for reducing utilization threatens the collaborative role of counselor-client relationship?

A) Pretreatment authorization of treatment
B) Concurrent utilization reviews
C) Incentives for efficient providers
D) Increased employee and user/client cost sharing

Question 21

Discuss the various trends that led to the move toward managed care? To what extent do you agree that such intervention was necessary?

Question 22

Discuss what specific measures are taken by managed care organizations to control the total costs of health care?

Question 23

As you contemplate the practice of mental health counseling in a managed care environment, how do you characterize your professional response - moving toward, moving away, or moving away? Why?

Question 24

List and describe the various managed care systems. How are they similar? What makes them different from one another?