Managed care plans hmo - Study guides, Class notes & Summaries

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...

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...

605 Midterm Question and answers correctly solved Managed Care - correct answer 1) acts as the insurance company and the providers of care. 2) Employs mechanisms to control (manage) utilization of medical services. 3) Determines the price at which the services are purchased and how much the providers get paid. 4) Is the most dominant health care delivery system in the United States and available to most Americans. This is includes both Health Maintenance Organizations (HMO) and Preferred Pr...

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...

Legal Contract - Consideration, Legal Purpose, Offer (Made by Insured), Acceptance, Competent Parties A commissioner must give how many days advance notice of a hearing? - 21 Days (Guaranteed Association) Maximum benefits for any one life- Life insurance cash values - $100,000 (Guaranteed Association) Maximum benefits for any one life- Life insurance death benefits - $300,000 (Guaranteed Association) Maximum benefits for any one life- Other health insurance benefits - $100,000 (Guarante...

A business offers a group disability income plan and pays the premiums. If an employee suffers a disabling injury, the benefits paid to the employee will be: - Answer-axable income to the business deductible income to the employee a deductible business expense for the business taxable income to the employee A business overhead expense policy does NOT provide: - Answer-tax-free benefits a Medicare SELECT plan is - Answer-a managed care policy. A Medicare SELECT plan is a - Answer-managed c...

Providers - Are people or organizations that provide health care, including doctors, nurses, clinics, and agencies. facilities - are places where care is delivered or administered, including, hospitals, long-term care facilities or nursing homes, and treatment centers. Payers - people or organizations paying for healthcare services long term care (LTC) - facilities, also called "nursing homes," "skilled nursing facilities," and "extended care facilities" are for people who need 24...

What Act shaped how commercial insurance carriers approached the concepts of paying for medical care? correct answer: HMO Act of 1973 ACA correct answer: Affordable Care Act HMO (Health Maintenance Organization) correct 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 correct answer: part of prospective payment in which healthcare p...

CPQA - ANSWER-certified professional in quality assurance When did CPHQ begin to advance the profession of quality and when was the first certification administered? - ANSWER-1976; Sept 8 1984 Board of Director's Quality Role - ANSWER-1. set policy 2. financial and strategic direction 3. quality of care 4. goals and objectives 5. establish quality priorities Leadership - ANSWER-ability to influence an individual or group toward achievement of a goal and includes determining the ...