Ffs fee for service Study guides, Class notes & Summaries

Mr. Davis is 52 years old and has recently been diagnosed with end-stage renal disease (ESRD) and will soon begin dialysis. He is wondering if he can obtain coverage under Medicare. What should you tell him?correct answersHe may sign-up for Medicare at any time however coverage usually begins on the fourth month after dialysis treatments start. Juan Perez, who is turning age 65 next month, intends to work for several more years at Smallcap, Incorporated. Smallcap has a workforce of15 emplo...

AHIP Final Exam Test Questions 2020-2024 FINAL EXAM 250 Q/A TEST BANK America's Health Insurance Plans (AHIP) Exam Study Guide Questions & Answers Mr. Davis is 52 years old and has recently been diagnosed with end-stage renal disease (ESRD) and will soon begin dialysis. He is wondering if he can obtain coverage under Medicare. What should you tell him? - ANSWER He may sign-up for Medicare at any time however coverage usually begins on the fourth month after dialy...

Edward IP suffered from serious kidney disease. As a result. Edward became eligible for Medicare coverage due to end-stage renal disease (ESRD). A close relative donated their kidney and Edward successfully underwent transplant surgery 12 months ago. Edward is now age 50 and asks you if his Medicare coverage will continue, what should you say? - ANSWER Individuals eligible for Medicare based on ESRD generally lose eligibility 36 months after the month in which the individual receives a kidney tr...

Mrs. Gonzalez is enrolled in Original Medicare and has a Medigap policy as well, but it provides no drug coverage. She would like to keep the coverage she has but replace her existing Medigap plan with one that provides drug coverage. What should you tell her? correct answersMrs. Gonzalez cannot purchase a Medigap plan that covers drugs, but she could keep her Medigap policy and enroll in a Part D prescription drug plan. Mrs. Chen will be 65 soon, has been a citizen for twelve years, has bee...

Mr. Davis is 52 years old and has recently been diagnosed with end-stage renal disease (ESRD) and will soon begin dialysis. He is wondering if he can obtain coverage under Medicare. What should you tell him? (Correct Answer) He may sign-up for Medicare at any time however coverage usually begins on the fourth month after dialysis treatments start. Juan Perez, who is turning age 65 next month, intends to work for several more years at Smallcap, Incorporated. Smallcap has a workforce of15 emplo...

What Act shaped how commercial insurance carriers approached the concepts of paying for medical care? - ANSWER-HMO Act of 1973 ACA - ANSWER-Affordable Care Act HMO (Health Maintenance Organization) - ANSWER-The organization is both the insurer and provider of a set of defined services. Patients within this network must use an in-network provider for their services to be covered. Capitation Payment - ANSWER-part of prospective payment in which healthcare providers receive fixed monthly p...

12.1% - ANSWER # of improper Medicare Fee-For-Service claim payments, according to Federal Government. FFS - ANSWER Fee-For-Service Prepayment Review - ANSWER Review of claims prior to payment. Prepayment reviews result in an initial determination. Postpayment Review - ANSWER Review of claims after payment. May result in either no change to the initial determination or a revised determination, indicating an underpayment or overpayment.

12.1% - ANSWER # of improper Medicare Fee-For-Service claim payments, according to Federal Government. FFS - ANSWER Fee-For-Service Prepayment Review - ANSWER Review of claims prior to payment. Prepayment reviews result in an initial determination. Postpayment Review - ANSWER Review of claims after payment. May result in either no change to the initial determination or a revised determination, indicating an underpayment or overpayment. Underpayment - ANSWER A payment a provider recei...

12.1% - Correct ️️ # of improper Medicare Fee-For-Service claim payments, according to Federal Government. FFS - Correct ️️ Fee-For-Service Prepayment Review - Correct ️️ Review of claims prior to payment. Prepayment reviews result in an initial determination. Postpayment Review - Correct ️️ Review of claims after payment. May result in either no change to the initial determination or a revised determination, indicating an underpayment or overpayment. Underpaymen

Medical Billing and Coding Lesson 1: Reimbursement, HIPAA, and Compliance Already Passed The Medical Coder's Responsibility Each coding system plays a critical role in reimbursement. The role of the medical coder is to optimize payment while adhering to coding guidelines. The coder must accurately code the services, procedures, and diagnosis rendered so that the office is properly reimbursed. Coders may encounter ethical issues about upcoding a procedure or changing a diagnosis to ob...