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

CSPR - Certified Specialist Payment Rep (HFMA) Questions with Correct Answers | Graded A+ 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 PP...

OTP 510 Final Exam Questions and Answers All Correct The following describes this managed care principle: Panels of health care providers who are contracted with the Managed Care Organization (MCO) provide services, are open or closed, and go through a credentialing process. The primary care physician serves as a gatekeeper to authorize services. - Answer-Limited access to the universe of providers The following describes this managed care product: This managed care product allows individ...

CSPR - Certified Specialist Payment Rep (HFMA) Exam 2024 With Correct Solutions Steps used to control costs of managed care include: - Answer -Bundled codes Capitation Payer and Provider to agree on reasonable payment 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 Identify the various types of private health plan coverage - Answer -HMO Conve...

Which insurance plan has a gate keeper physician? Health Maintenance Organization HMO Which insurance plan has members choose any provider but preferred providers offer decreased medical services costs and lower deductibles? Preferred Provider Organization. What does a gate keeper physician do? Preapproves specialist visits Which insurance plan works like an HMO but physicians are only paid based on the services they provide? Exclusive Provider organization Which has lower premiums E...

Revenue Cycle Management Final 100% Correct Review Test 2023 Update enter an X in both the Medicare and Medicaid boxes of Block 1 - ANS-When completing a CMS-1500 claim for Medicare-Medicaid (Medi-Medi) crossover claims: a. enter an X in both the Medicare and Medicaid boxes of Block 1 b. enter MCD followed by the patient's Medicaid ID number in Block 10b c. enter MEDIGAP in Block 9a d. complete two claims, one each for Medicare and Medicaid E/M services - ANS-Major revisions to CPT...

Which of the following types of health insurance covers the cost of providing non-medical custodial care to individuals with cognitive problems? A. Disability income insurance B. Long-term care insurance C. Hospital expense coverage D. Medical Expense coverage B All of the following are characteristics of a group health insurance plan EXCEPT: A. Only group members may be covered. B. There is one master contract B. Each person has a policy D. Benefits are essentially the same for al...

Which of the following types of health insurance covers the cost of providing non-medical custodial care to individuals with cognitive problems? A. Disability income insurance B. Long-term care insurance C. Hospital expense coverage D. Medical Expense coverage B All of the following are characteristics of a group health insurance plan EXCEPT: A. Only group members may be covered. B. There is one master contract B. Each person has a policy D. Benefits are essentially the same for al...

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...

GBA 1 - Study Guide Questions and Answers Rated A+ What was the purpose of the Health Maintenance Organization Act of 1973? The health maintenance organization action of 1973 provided federal initiatives - consisted of federal grants and loans to organizations wishing to investigate the feasibility of "federally qualified HMO" How did the passage of the Health Maintenance Organization Act of 1973 affect the growth of HMOs? The government began to withdraw its funding during the Reagan adminis...

CPMSM Study Guide Questions and Answers Fully solved 2024 Non-profit under religious/community control. Voluntary/Charitable Hospital Non-profit under city, state, county. Govt (non-federal) hospital Brainpower Read More Previous Play Next Rewind 10 seconds Move forward 10 seconds Unmute 0:07 / 0:15 Full screen Owned/operated by fed gov't, supported by fed funds, e.g., VA. Under direct supervision of Surgeon General. Govt (federal) hospital Owned by corpor...