Certified Revenue Cycle Representative (CRCR) Practice Exam

Which of the following describes the purpose of site-of-service limitations in managed care plans?

1. To encourage members to use more providers

2. To restrict coverage to select locations for cost-effectiveness

3. To eliminate all out-of-network benefits

4. To ensure members receive care promptly

The correct answer is: To restrict coverage to select locations for cost-effectiveness

The purpose of site-of-service limitations in managed care plans is primarily to restrict coverage to select locations for cost-effectiveness. Managed care organizations implement these limitations to manage healthcare costs and improve resource utilization. By directing members to specific sites, such as in-network hospitals or clinics, they can negotiate better rates and ensure more standardized care, which often results in lower overall expenses for both the member and the plan. This approach helps the plan maintain a sustainable cost structure while still providing necessary services. It also ensures that members receive care from facilities that are known to meet certain quality standards and cost control measures, thus enhancing the efficiency of the healthcare system.