RHIA Domain 4 Exam Study Questions with 100% Correct Solutions | Latest Update
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Course
RHIA Domain 4
Institution
RHIA Domain 4
Types of HMOs - Answer Group model HMO, independent practice association, network
model HMO, staff model HMO
PFFS - Answer You can see any doctor, other healthcare providers, or hospitals as long
as they agree to treat you. The plan determines how much it will pay for services
received
SNP - A...
RHIA Domain 4 Exam Study Questions with
100% Correct Solutions | Latest Update
Types of HMOs - Answer Group model HMO, independent practice association, network
model HMO, staff model HMO
PFFS - Answer You can see any doctor, other healthcare providers, or hospitals as long
as they agree to treat you. The plan determines how much it will pay for services
received
SNP - Answer Plans for those with special needs such as: live in a nursing home, have
both Medicaid and Medicare, have certain chronic medical conditions
HMOPOS & MSA - Answer HMO point of service plan. May allow out of network
services. Medical savings account plan. Combine high deductible plan with bank
account, Medicare deposits money into account, use money to pay for services
Medigap - Answer Supplemental insurance; private health insurance that pays, within
limits, most of the healthcare services charges not covered by Medicare parts A & B
Key performance indicators - Answer Allow healthcare facilities to measure and
benchmark their data against best practices
MAP keys - Answer Performance indicators developed for revenue cycle excellence
Hospice - Answer A program of palliative care that addresses the physical, spiritual,
social, and economical needs of terminally ill patients and their families
, Home health agency - Answer An organization that provides a blend of home based
medical and social services to homebound patients and their families
Respite care - Answer Temporary institutional care of a sick, elderly, or disabled person,
providing relief for their usual caregiver
Managed care - Answer Works to control the cost of, and access to, healthcare services
at the age time that they strive to meet high quality standards
NCQA - Answer Non-profit organization that accredits, assesses, and reports on the
quality of managed care plans in the United States
HEDIS - Answer A set of standardized measures used to compare managed care plans in
terms of the quality of services they provide
Joint commission - Answer Evaluates and accredit more than 20,000 health care
organizations and programs in the United States
Coordination of benefits transactions - Answer The determination of which insurance
policy is primary and which is secondary to prevent duplications of benefits being paid
Explanation of benefits - Answer A statement sent by a third party payer to the patient
to explain services provided amounts billed, and payments made by the health plan
Medicare summary notice - Answer Shows how much the provider billed, how much
Medicare reimbursed the provider, and what the patient must pay the provider by way
of deductible and copayments
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