Practice Quiz

Managed Care Nursing

Category - Overview

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A 45-year-old male is insured through his employer by an MCO plan. He also has coverage under his wife’s MCO plan with the State. He was injured at work and will require inpatient, outpatient, and home care services.

What will be necessary for the MCOs to ensure there is not duplication of services and/or payments
  1. Claim forms submitted
  2. Appeals
  3. Cost sharing
  4. Coordination of benefits
  5. Nothing. There are automatic notifications with EMR systems.
Explanation
Answer: D - The MCOs use coordination of benefits to ensure there is not a duplication of services and/or payments.
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