Hmo pos - Study guides, Class notes & Summaries

Nevada Life and Health License Exam Prep Questions with 100% Correct Answers What are the four required elements of an insurance contract? - Answer- Agreement, consideration, competent parties, and legal purpose. What two parts make up a life insurance application? - Answer- General Information and the Medical Information. An agent's report can go in a life insurance application but is not included in the life insurance policy. When must insurable interest exist in life insurance? - Answe...

AHIP CERTIFICATION 2024 EXAM QUESTIONS AND DETAILED ANSWERS| A+ GRADE Mr. Zachow has a condition for which three drugs are available. He has tried two but had an allergic reaction to them. Only the third drug works for him and it is not on his Part D plan's formulary. What could you tell him to do? Correct Answer Mr. Zachow has a right to request a formulary exception to obtain coverage for his Part D drug. He or his physician could obtain the standardized request form on the plan's web...

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 Conventional PPO and POS HDHP/SO plans - high-deductible health plans with a s...

CSPR - Certified Specialist Payment Rep (HFMA) Questions and Answers 2023 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 H...

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 Conventional PPO and POS HDHP/SO plans - high-deductible health plans with a savings...

Steps used to control costs of managed care include: correct answers Bundled codes Capitation Payer and Provider to agree on reasonable payment DRG is used to classify correct answers 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 correct answers HMO Conventional PPO and POS HDHP/SO plans - high-deductible health...

1. Milton is retiring on his 65th birthday. He is eligible for Medicare and already receives Social Security benefits. How does he enroll in Original Medicare? -He can only sign up for Medicare Parts A and/or B at his local Social Security office. -He can sign up for Medicare Parts A and/or B with any licensed insurance agent. -His enrollment in Medicare Parts A and B is generally automatic if he meets all eligibility requirements -He must enroll in Medicare Parts A and B through his current...

AHIP - Final Examination (Latest Update 2022) Mr. Zachow has a condition for which three drugs are available. He has tried two but had an allergic reaction to them. Only the third drug works for him and it is not on his Part D plan's formulary. What could you tell him to do? - Mr. Zachow has a right to request a formulary exception to obtain coverage for his Part D drug. He or his physician could obtain the standardized request form on the plan's website, fill it out, and submit it to his ...

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...

UHC Medicare Basics Test A consumer currently has original Medicare and is enrolled in a stand alone prescription drug plan what will happen if the consumer enrolls in an MA plan that has integrated prescription drug coverage - ANSWER-the consumer will be automatically disenrolled from the standalone PDP upon in Roman in the MA plan that has integrated prescription drug coverage aside from a standalone Medicare prescription drug plan how else could a Medicare eligible consumer get Part ...