Hmo pos - Study guides, Class notes & Summaries

2023 Medicare Basics Test Questions with Correct Answers In which two parts of Medicare is enrollment generally automatic for eligible consumers who are receiving social security benefits, unless they choose to delay their coverage? - Correct Answer Parts A and B Which statement is true about a member of a Medicare Advantage Plan who wants to enroll in a Medicare Supplement Insurance Plan? - Correct Answer When a consumer enrolls in a Medicare Supplement Insurance Plan, they are not automati...

CSPR - Certified Specialist Payment Rep (HFMA) Exam (Latest 2024) Questions & Verified Answers 100% Guaranteed Grade A+ Example Question & Answer: Identify the various types of government‐sponsored health coverage: - Answer - Medicare - Government; Beneficiaries enrolled in such plans, but, participation in these plans is voluntary. Medicaid Medicaid Managed Care - Medicaid beneficiaries are required to select and enroll in a managed care plan. Medicare Managed Care (a.k.a. Medicare ...

CSPR - Certified Specialist Payment Rep (HFMA) Steps used to control costs of managed care include: - CORRECT ANSWER-Bundled codes Capitation Payer and Provider to agree on reasonable payment DRG is used to classify - CORRECT ANSWER-Inpatient admissions for the purpose of reimbursing hospitals for each case in a given category w/a negotiated fixed fee, regardless of the actual costs incurred Identify the various types of private health plan coverage - CORRECT ANSWER-HMO Conventional ...

Steps used to control costs of managed care include: correct answer: Bundled codes Capitation Payer and Provider to agree on reasonable payment DRG is used to classify correct answer: Inpatient admissions for the purpose of reimbursing hospitals for each case in a given category w/a negotiated fixed fee, regardless of the actual costs incurred Identify the various types of private health plan coverage correct answer: HMO Conventional PPO and POS HDHP/SO plans - high-deductible hea...

CSPR - Certified Specialist Payment Rep (HFMA) questions with correct answers 1. Steps used to control costs of managed care include :Answer: Bundled codes Capitation Payer and Provider to agree on reasonable payment 2. DRG is used to classify:Answer: Inpatient admissions for the purpose of reimbursing hospitals for each case in a given category w/a negotiated fixed fee, regardless of the actual costs incurred 3. Identify the various types of private health plan coverage:Answer: HMO Conven...

Steps used to control costs of managed care include: - CORRECT ANSWER-Bundled codes Capitation Payer and Provider to agree on reasonable payment DRG is used to classify - CORRECT ANSWER-Inpatient admissions for the purpose of reimbursing hospitals for each case in a given category w/a negotiated fixed fee, regardless of the actual costs incurred Identify the various types of private health plan coverage - CORRECT ANSWER-HMO Conventional PPO and POS HDHP/SO plans - high-deductible heal...

A 6 year-old is seen in the pediatrician office for the first time. He has insurance coverage through both his mother (DOB: 02/08/86 and his father (DOB: 05/15/85). Whose insurance is primary? A. Mother's insurance plan B. Father's insurance plan C. The policy that has the best benefits D. Either mother's or father's insurance plan depending who brings the child in for medical care. - A. Mother's insurance plan Which managed care plan has the patient receiving care from participating p...

Nevada Life and Health Insurance Final Exam Questions and Answers Rated A+ What is an individual engaged in the solicitation, negotiation, or sell of funeral expense insurance who is required to be licensed by the state? Prepaid funeral contract agent Which of the following does the Nevada Insurance Commissioner NOT do? Make statutes concerning insurance law Nick has a policy that the insurer can cancel when he turns 65. Which type of policy is it? Conditionally renewable Which o...

A 6 year-old is seen in the pediatrician office for the first time. He has insurance coverage through both his mother (DOB: 02/08/86 and his father (DOB: 05/15/85). Whose insurance is primary? A. Mother's insurance plan B. Father's insurance plan C. The policy that has the best benefits D. Either mother's or father's insurance plan depending who brings the child in for medical care. Answer A. Mother's insurance plan Which managed care plan has the patient receiving care from pa...

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...