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

H has suffered a covered disability away from her job and will shortly begin collecting benefits. The insurer sends a letter to H stating that she will not receive any benefit amounts greater than her income. This clause is known as: A: Over-insurance clause B: free look C: relation of earning to insurance D: relation of economic value - answer-C: relation of earning to insurance The insured should be aware of the issue date upon delivery a policy and the date should be listed on: A: the...

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...

NY Series 17-52 Questions and Answers 100% Pass How many eligible employees must be included in a contributory health insurance plan? 50% A man works for Company A and his wife works for Company B. The spouses are covered by health plans through their respective companies that also cover the other spouse. If the husband files a claim, The insurance through his company is primary. What is the period of coverage for events such as death or divorce under COBRA? 36 months Twenty-five days after ...

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...

What Act shaped how commercial insurance carriers approached the concepts of paying for medical care? - ANSWER-HMO Act of 1973 ACA - ANSWER-Affordable Care Act HMO (Health Maintenance Organization) - ANSWER-The organization is both the insurer and provider of a set of defined services. Patients within this network must use an in-network provider for their services to be covered. Capitation Payment - ANSWER-part of prospective payment in which healthcare providers receive fixed monthly p...

ANCC Risk mgt / ethics / research Exam 93 Questions with Verified Answers What are some systematic components to reducing risk? What does it begin with? - CORRECT ANSWER Begins with a formal written plan -organizational goals -delineation of program scope, components, methods -delegating responsibility for implementation and enforcement -commitment of the board -guarantees of confidentiality and immunity for those who squeal goals -> scope/methods -> delegation -> board b...

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 Identify the various types of private health plan coverage correct answer: HMO Conventional PPO and POS HDHP/SO plans - high-deductible hea...