Certified Revenue Cycle Representative (CRCR) Practice Exam

What are examples of managed care plans?

1. Exclusive Provider Organizations (EPO).

2. Health Maintenance Organizations (HMO).

3. Preferred Provider Organizations (PPO).

4. All of the above.

The correct answer is: All of the above.

Managed care plans are designed to provide cost-effective healthcare while ensuring adequate care for members. They typically involve a network of providers and various levels of managed care arrangements. Exclusive Provider Organizations (EPO) are one type of managed care plan that offers a network of providers but does not cover any out-of-network care except in emergencies. This structure encourages patients to seek care specifically within the approved network, enabling cost control and streamlined care management. Health Maintenance Organizations (HMO) are another example where members are required to choose a primary care physician and obtain referrals to see specialists. HMOs emphasize preventative care and typically have lower out-of-pocket costs, making them appealing for managing overall health expenses. Preferred Provider Organizations (PPO) provide greater flexibility by allowing members to see any healthcare provider, though they receive higher benefits when using the network's preferred providers. This balance between flexibility and cost management makes PPOs a popular choice among those who seek a wider choice of healthcare providers. Since EPOs, HMOs, and PPOs all represent different models of managed care plans, the inclusion of all these types in the answer accurately reflects the variety within the managed care landscape.