Savings providers - Study guides, Class notes & Summaries

A small, rural hospital is part of an Accountable Care Organization (ACO) and is designated as a Level 1 ACO. What is part of this designation? p. 2 a. Bonuses based on achievement of benchmarks b. Care coordination for chronic diseases c. Standards for minimum cash reserves d. Strict requirements for financial reporting Answer ANS: A A Level 1 ACO has the least amount of financial risk and requirements, but receives shared savings bonuses based on achievement of benchmarks for quality meas...

Test Bank For Primary Care Interprofessional Collaborative Practice 6th Edition by Terry Maham Buttaro Chapters 1-228| Full & Complete Guide A+. Chapter 01: Interprofessional Collaborative Practice: Where We Are Today Buttaro: Primary Care: A Collaborative Practice, 6th Edition MULTIPLE CHOICE 1. A small, rural hospital is part of an Accountable Care Organization (ACO) and is designated as a Level 1 ACO. What is part of this designation? a. Bonuses based on achievement of benchmarks b. C...

Hard Savings correct answers directly related to the case manager actions Soft Savings correct answers potential savings, costs avoided BECAUSE of case manager intervention How to calculate Cost Savings correct answers Potential Costs - (Actual Cost + Cost of Case Management) What is a Cost Benefit Analysis correct answers a report that documents savings related to case management involvement Predictive modeling correct answers identifies which members will incur the highest future m...

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...

HIPAA Questions and Answers with Certified Solutions State or local laws can never override HIPAA. False Protected health information (PHI) requires an association between an individual and a diagnosis. True Some covered entities are exempted under HIPAA from submitting claims electronically using the standard transaction format. True The acronym EDI stands for Electronic data interchange. Which group of providers would be considered covered entities? a. Rehabilitation center, same-day sur...

CCM2019 PRACTICE QUESTIONS FOR TEST. WITH COMPLETE SOLUTIONS 100% 2023/2024 Diagnostic related groups were developed to: Pay hospital rate. To coordinate cost effective quality homecare products and services the case manager should: Critically assess providers A type of health care insurance that covers out of pocket cost for Medicare covered services is: Medigap Which of the following statements best defines return on investment ROÍ? The ratio of care cost to savings. ...

The 501(r) regulations require not-for-profit providers 501(c) (3) to do which of the following activities? A. Complete a community needs assessment and develop a discount program for patient balances after insurance payment. B. Pursue extraordinary collection activities with all patients eligible for financial assistance. C. Implement a financial assistance program for uninsured and underinsured patients. D. Discount all charges to self-pay patients to an amount generally billed to all othe...

1. Which assessments of care providers are performed as part of the Value Based Purchasing initiative? Select all that apply. a. Appraising costs per case of care for Medicare patients b. Assessing patients’ satisfaction with hospital care c. Evaluating available evidence to guide clinical care guidelines d. Monitoring mortality rates of all patients with pneumonia e. Requiring advanced IT standards and minimum cash reserves ANS: A, B, D Value Based Purchasing looks at five domain are...

Stanhope: Foundations for Population Health in Community/Public Health Nursing, 5th Edition TESTBANK Chapter 01: Community- and Prevention-Oriented Practice to Improve Population Health Stanhope: Foundations for Population Health in Community/Public Health Nursing, 5th Edition MULTIPLE CHOICE 1. Which of the following best describes community-based nursing? a. A practice in which care is provided for individuals and families b. Providing care with a focus on the group’s needs c. G...

NEA-BC PROFESSIONAL PRACTICE WITH COMPLETE SOLUTIONS 100% Accountable Care Organization (ACO) - correct answer An organization of healthcare providers accountable for the quality, cost, and overall care of Medicare beneficiaries who are assigned and enrolled in the traditional fee-for-service program Purpose: improve delivery of care and save costs Coordination of care Shared Savings Program - correct answer ACO payment is made for participants under fee for service who meet performance...