Mco insurance - Study guides, Class notes & Summaries

When are patients eligable for medicare? CORRECT ANSWER 65 or those with permanent diabilites medicaid for patients with CORRECT ANSWER low incomes MCO insurance CORRECT ANSWER managed care organizer: prevention and health promotion PPO CORRECT ANSWER preferred provider organizations EPO insurance CORRECT ANSWER exclusive provider orgnaizatoin (no out o fnetwork coverage) long term care insurance CORRECT ANSWER used a s supplement: for what medicare doesn't cover emphasizes he...

Access Fee - correct answer Fee charged by an MCO for access to its provider network, including its reimbursement terms, by an employer/MCO Accrual - correct answer The amount of money that is set aside to cover expenses ACG (Ambulatory Care Group) - correct answer Method of categorizing outpatient episodes ACR - correct answer (Adjusted Community Rate) Adjudication - correct answer The management and pricessing of claims by an MCO or health insurance company Admitted asset - corr...

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...

Do you shoot the dog? - Answer yes What do you use to package wet evidence? - Answer paper bag VIN - Answer vehicle identification number LEIN - Answer law enforcement information network NICB - Answer national insurance crime bureau NCIC - Answer national crime information center PIN - Answer product identification number UDAA - Answer unlawfully driving away an automobile two parts of every vehicle theft - Answer stolen, recovered two types...

ACO correct answers An acronym for Accountable Care Organization Actuary correct answers A person in the insurance field who decides insurance policy rates and reserves dividends, as well as conducts various other statistical analyses Parternship for Health ACT 1966 correct answers recognized health promotion and illness prevention as a " State of complete physical, mental, social well being Assessment tool and diagnostic tests correct answers tools used for evaluating risk and outcome...

NURS 101 HESI EXAM 2023/2024 ACCURATE EXPERT VERIFIED WITH RATIONALES FOR GUARANTEED PASS LATEST UPDATE. An octogenarian client asks the nurse about the United States' government-funded national health insurance program. About which healthcare plan should the nurse inform the client? A. Medicare B. Long-term care insurance C. Private insurance D. Preferred provider organization A. Medicare. Medicare is a government-funded national health insurance program for people 65 years and older in the ...

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 Provider Organizations (PPO). 5) Employers and g...

RHIA DOMAIN 4 EXAM QUESTIONS AND ANSWERS What 3 organizations does CMS recognize for accreditation? - Answer-Joint Commission DNV AOA This certification process is conducted by a state agency, usually the Department of Health and Human Services, on behalf of the Centers for Medicare and Medicaid Services (CMS).Some states and Medicare accept accreditation from specific accreditation organizations as the basis for partial or full licensure. This policy is called _____________ - Answer-deeme...

Certified Specialist Payment Rep (CSPR) HFMA 2024/25 Review-Steps used to control costs of managed care include: - Bundled codes Capitation Payer and Provider to agree on reasonable payment DRG is used to classify - 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 - HMO Conventional PPO and POS HDHP/SO plans - high...

managed care - seeks to achieve efficiency by integrating the basic functions of health care delivery, and it employs mechanisms to control (manage) utilization and cost of medical services. The dominant health care delivery system in the US today. Covers both private and public health insurance programs through contracts with a MCO. military - medical care system available mostly free of charge to active duty military personnel of the US army, navy, air force, and coast guard, as well ...