A health care provider has charged more than a managed care organizati

A health care provider has charged more than a managed care organization (MCO) typically pays for a procedure. Which of the following would most likely be the result?

a. Provider may be removed from the MCO’s list of approved providers.
b. The MCO will re-examine the payment for that procedure.
c. Provider would get the typical payment instead of what was charged.
d. The MCO would be forced to increase its typical payment for that procedure.

ESSAYBID ANSWER

ANS: C
MCOs may deny reimbursement to health care providers who exceed the expected costs. Therefore, at least on the first occasion, the most probable result would be that the provider gets the listed payment, not what the provider charged.