What is a ppo plan - Study guides, Class notes & Summaries

AHIP FINAL EXAM QUESTIONS AND DETAILED ANSWERS MARCH 2024 LATEST GRADED A+. Mr. Davis is 52 years old and has recently been diagnosed with end- stage renal disease (ESRD) and will soon begin dialysis. He is wondering if he can obtain coverage under Medicare. What should you tell him? Correct Ans - He may sign-up for Medicare at any time however coverage usually begins on the fourth month after dialysis treatments start. Juan Perez, who is turning age 65 next month, intends to work for seve...

The level of hospice care where family members provide a significant amount of the care: 1) Respite Care 2) General In-Patient Care 3) Continuous Home Care 4) Routine Home Care - 4 What is the minimum length of time that resident medical records must be retained? 1) 7 years 2) 5 years 3) 10 years 4) 3 years - 2 A health insurance plan where members can go to any Medicare-approved doctor or hospital: 1) HMO (Health Maintenance Organization) 2) SNP (Special Needs Plan) 3) PPO (Preferr...

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...

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...

AHIP 2023/2024 FINAL EXAM REAL Q&A EXPERT VERIFIED GUARANTEED PASS LATEST UPDATE. Ramos is considering a Medicare Advantage PPO and has questions about which providers she can go to for her health care. What should you tell her? Mrs. Ramos can obtain care from any provider who participates in Original Medicare, but generally will have a higher cost-sharing amount if she sees a provider who/that is not a part of the PPO network. Romero is 64, retiring soon, and considering enrollment in his emplo...

Mrs. West wears glasses and dentures and has enjoyed considerable pain relief from arthritis through acupuncture. She is concerned about whether or not Medicare will cover these items and services. What should you tell her? - Medicare does not cover acupuncture, or, in general, glasses or dentures. Mr. Bickford did not quite qualify for the extra help low-income subsidy under the Medicare Part D Prescription Drug program and he is wondering if there is any other option he has for obtaining...

AHIP Final Exam Latest Questions and Answers 2024 (verified answers) Mr.Gomez notes that a Private Fee for Service (PFFS) plan avaliable in his area has an attractive preminum. He wants to know if he must use doctors in a network as his current HMO plan requires him to do. What should you tell him? - ANSWERS He may receive health care services from any doctor allowed to bill Medicare as long as he shows the doctor the plan's identification card and the doctor agrees to accept the PFFS...

Florida 6-20 All Lines Adjuster Test| 276 questions| 50 Pages| With Complete Solutions Florida 6-20 All Lines Adjuster Test| 276 questions| 50 Pages| With Complete Solutions A public adjuster represents the interest of: A. The insurer B. The Insured C. The employer D. The interest of the general public - Correct Answer -B. The insured Which of the following is the type of report that indicates the initial results of a claim investigation? A. Field Report B. Interim Report C. Full Re...

Mrs. West wears glasses and dentures and has enjoyed considerable pain relief from arthritis through acupuncture. She is concerned about whether or not Medicare will cover these items and services. What should you tell her? - Medicare does not cover acupuncture, or, in general, glasses or dentures. Mr. Bickford did not quite qualify for the extra help low-income subsidy under the Medicare Part D Prescription Drug program and he is wondering if there is any other option he has for obtaining hel...

AHIP Final Exam Test Updated Questions and Answers (2024 / 2025) (Verified Answers).1. Mrs. West wears glasses and dentures and has enjoyed considerable pain relief from arthritis through acupuncture. She is concerned about whether or not Medicare will cover these items and services. What should you tell her ANS Medicare does not cover acupuncture, or, in general, glasses or dentures. 2. Mr. Bickford did not quite qualify for the extra help low-income subsidy under the Medicare Part D Prescrip...