Capitation payment - Study guides, Class notes & Summaries

Maine Life Insurance Exam Questions With Complete Solutions. Contributory Health Insurance If the employees share a portion of the premium. Often require participation by 75% of eligible members. Noncontributory Health Insurance If the employer pays the entire premium. Most require 100% participation by eligible members. (Funding of Group Insurance) Shared funding Allows employer to self-fund health care expenses, select a deductible and pay covered expenses for any individual incurring ...

Calculate the amount of money a patient would owe for a noncovered service costing $900 if their indemnity policy has a coinsurance rate of 80-20, and they have already met their deductible correct answers $900 Calculate the monthly capitation payment a provider should receive from a health plan if they have 80 contracted patients and a capitated payment of $40 per month correct answers The monthly capitation payment would total $3,200 (80 x $40 = $3,200). A capitated payment amount is cal...

What is respondeat superior or vicarious liability? - ANSWER ☑☑it is when an employer is responsible for the actions of their employees. Both terms essentially mean the same thing. what is res ipsa loquitur? - ANSWER ☑☑it is when a physician acts negligently to lead to an accident. the thing speaks for itself Example is if a physician prescribes the wrong medication leading to injury or leaves a scalpel inside someone . What is contributory negligence? - ANSWER ☑☑it is...

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...

CNML Test Exam Questions Revised With Correct Answers < Updated & Already Passed > DRGs - ANSWER : Diagnostic-Related Groups: payment rate based on specific diagnoses Prospective Payment System - ANSWER : Used by Medicare-participating hospitals: pretreatment diagnosis billings based on DRGs; rate decided ahead of time between insurance companies and hospitals Exclusive Provider - ANSWER : Used by HMO's: insurance coverage for contracted providers or institutions ...

Knowing which of the following can best assist a technician in the prevention of data entry errors? A. Names of medications B. Insurance co-payments C. Pharmacokinetics D. Physician contact information - correct answerA. Names of medications Which of the following injectable drugs would be stored in refrigerator? A. Clindamycin B. Ciprofloxacin C. Cyanocobalamin D. Calcitonin-salmon - correct answerD. Calcitonin-salmon The requirement that a non-formulary medication be covered ...

Management functions correct answers key functions of a manager including planning, organizing, staffing, directing & controlling Management connective processes correct answers mgmt functions that connect elements of the healthcare org. including communicating, coordinating and decision making Joint Commission correct answers primary accrediting organization for healthcare orgs. Healthcare Financial Mgmt Association (HFMA) correct answers Association of healthcare financial managers; c...

CSPR - Certified Specialist Payment Rep (HFMA) UPDATED Actual Exam Questions and CORRECT Answers 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

Medical billing and coding latest version graded A+ Medical Insurance Financial plan (the payer) that covers the cost of hospital and medical care Policyholder Person who buys an insurance plan; the insured, subscriber, or guarantor Health Plan Individual or group plan that provides or pays for the cost of medical care Benefits What a health plan pays for services covered in an insurance policy; listed in the schedule of benefits. Medical Necessity Reasonable services of prov...

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 ...