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Complete Healthcare Reimbursement Q&A Bundle

Master Healthcare Reimbursement with the Complete Q&A Bundle!

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Healthcare Reimbursement Ch. 8 Test Questions and Correct Answers

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Activities of daily living (ADL) Everyday tasks that people can perform without assistance and that are used to measure their functional status and, thus, their need for institutional or assisted care. Average length of stay (ALOS) Average number of days patients are hospitalized. Base rate 1. Rat...

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Healthcare Reimbursement Chapter 5 Review Questions and Correct Answers

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Arithmetic Mean Length of Stay (AMLOS) Sum of all lengths of stay in a set of cases divided by the number of cases. Base Payment Rate 1) Rate per discharge for operating and capital-related components for an acute-care hospital. 2) Prospectively set payment rate made for services that Medicare bene...

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Healthcare Reimbursement Review Questions and Correct Answers

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Health Care Financing Administration Created in 1977 to coordinate and administer Medicare and Medicaid HIPPA provisions 1. Ensures coverage for preexisting conditions 2. Protects against discrimination based on health status 3. Right to purchase individual plan Healthy People 2000 objectives 1. H...

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Principles of Reimbursement Study Questions and Correct Answers

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In which type of healthcare payment method, does the healthcare plan recompense providers each month with a set amount of money for each individual enrolled in the healthcare plan? Capitated rate In which type of healthcare payment method does the healthcare plan pay for each service that a provide...

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Healthcare Reimbursement Mid-Term Exam Questions and Correct Answers

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ICD-10-CM The coding system that is used primarily for reporting diagnoses for hospital inpatients CPT coding systems created for reporting procedures and services performed by physicians in clinical practice? WHO ICD is maintained by lessons learned from RAC demonstration -RACs are able to find ...

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Reimbursement Quizzes 1, 3, 4, 5, 7-A, 7-B, 8-A, 8-B, 9, 2, 6, & 10 Final Review Q2uestions and Answers

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There are 3 parties in healthcare reimbursement. Who is the second party? Provider of care or services All of the following methods are types of episode-of-care reimbursement EXCEPT: Self-insured plan Which of the three models for health systems predominates in the United States? Private health in...

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Healthcare Reimbursement Study Guide with Questions and Correct Answers

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What are the two types of reimbursement systems Fee-for-service and episode-of-care fee-for-service a system under which doctors and hospitals receive a payment for each service they provide Episode-of care Payment based on services provided for conditions for which the patient is treated. 3 exam...

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Healthcare Reimbursement-Chapter 2 Test Questions and Correct Answers

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HIPAA (Health Insurance Portability and Accountability Act) Designated the code sets for healthcare services reporting to public and private insurers. HITSP (Health Information Technology Standards Panel) identified standards for the electronic exchange of health information NCHS (National Center ...

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PRINCIPLES OF HEALTHCARE REIMBURSEMENT STUDY GUIDE WITH QUESTIONS AND SOLUTIONS

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AHA CODING CLINIC FOR HCPCSAHA CODING CLINIC FOR ICD-10-CM & ICD-10 PCS A publication issued quarterly by the American Hospital Association & approved by the Centers for MC & MK Services (CMS) to give coding advice & direction for International Classification of Diseases, 10th Revision, Clinical Mod...

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Healthcare Reimbursement Chapter 6 Test Questions and Correct Answers

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Balance billing Allowing the provider to charge the patient the difference of the allowed amount from insurance Allowed charge The allowable charge, or payment set by the health care plan for each covered service. This is the maximum fee the health plan will pay for that service or procedure. What...

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Healthcare Reimbursement Methodologies Test Questions and Correct Answers

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Healthcare reimbursement methodologies breakdown into two primary types: 1- Fee-For-Service, Reimbursement based on: •Services provided to the patient 1.Self-pay 2.Retrospective payment 3.Managed care 2. Episode-of-Care, Patient's condition/illness •A specified time period 1.Managed care - cap...

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Reimbursement Methodologies Practice Questions and Correct Answers

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Episode-of-Care determine payment based on one lump sum payment for all the care provided related to a disease or particular condition. (time factor) - unit of time may be daily, monthly, or other specific time period Managed Care- Capitation Reimbursement method - third-party payer contracts with ...

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Principles of Healthcare Reimbursement & Revenue Cycle Management Questions and Answers

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In this healthcare delivery model, the government is the only payer that funds universal healthcare coverage through taxes NATIONAL INSURANCE MODEL In this healthcare delivery model, the insurance company determines that contribution amount that is not based on the policyholder's income PRIVATE IN...

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HIM 151(PRINCIPLES OF HEALTHCARE REIMBURSEMENT) 5TH EDITION QUESTIONS AND CORRECT ANSWERS

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What is the name of your state's insurance commission? Bureau of Insurance What is the mission of your state's insurance commission? to ensure that citizens of the Commonwealth are provided with access to adequate and reliable insurance protection; that the insurance companies selling policies ar...

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HIM 2330 Healthcare Reimbursement Review Questions and Correct Answers

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Why do health insurers pool premium payments for all the insureds in a group and use actuarial data to calculate the group's premiums? To assure that the pool is large enough to pay losses of the entire group Dr. Gilbert sees a 14-old-male with adolescent idiopathic thoracic scoliosis. Surgery for...

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Chapter 4 Healthcare Reimbursement Methodologies Study Questions and Correct Answers

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What is the difference between retrospective and prospective reimbursement? Retrospective reimbursement is based on the actual resources expended to deliver the services and is finalized after the services are delivered. Prospective reimbursement is established prior to the healthcare delivery and d...

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Principles of Healthcare Reimbursement, Chp 1, Part 1 Questions and Correct Answers

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The US healthcare system is inherently complex because it is actually multiple subsystems rather than a single system Insurance a system of reducing a person's exposure to risk of loss by having another party (insurance company or insurer) assumes the risk Risk pool group of persons with similar ...

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Healthcare Reimbursement Systems Review Questions and Correct Answers

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Prospective payment system reimbursement methodology that establishes predetermined rates based on patient category or type of facility Prospective cost-based rates healthcare costs from which a prospective per diem rate is determined - this method may be based on case-mix Prospective price-based ...

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Reimbursement in Healthcare Exam Questions and Correct Answers

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Why is Healthcare reimbursement different from other industries? 1. Patients often is not the person who pays 2. Complex contractual relationships between, patient, government, third-party payer, & provider 3. The dollar amount collected by the provider may vary widely depending on who pays 4. The g...

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Healthcare Reimbursement Ch. 3 Study Questions and Correct Answers

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Actual charge Amount provider actually bills a patient, which may differ from the allowable charge. Adjudication The determination of the reimbursement payment based on the member's insurance benefits. Adjustment Amount that healthcare insurers deduct providers' payments per contracted discounts...

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Healthcare Reimbursement Ch. 5 Practice Questions and Correct Answers

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Capitation Method of payment for health services in which an individual or institutional provider is paid a fixed, per capita amount for each person enrolled without regard to the actual number or nature of services provided or number of persons served. Carve-out Contracts that separate out service...

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Healthcare Reimbursement Practice Exam Questions and Correct Answers

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Payer System The United States has a first-party and third-party payment system: first-party = patient third-party = other entity Other Entity: - Government (Medicare/Medicaid) - Group/Individual Insurers - Industrial/Worker's Comp - Automobile Insurers - Liability Insurers - Charitable Organizat...

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