Primary payer Study guides, Class notes & Summaries

Version 1 1 McGraw-Hill's Taxation of Individuals and Business Entities 2023 Edition 14th Edition by Brian Spilker Benjamin Ayers John Barrick Troy Lewis John Robinson Version 1 2 TRUE/FALSE - Write 'T' if the statement is true and 'F' if the statement is false. 1) Taxes influence many types of business decisions but generally do not influence personal decisions. ⊚ true ⊚ false 2) Taxes influence business decisions such as where a business should locate or how a business should...

CRCR Exam Prep What are collection agency fees based on? - correct answer A percentage of dollars collected Self-funded benefit plans may choose to coordinate benefits using the gender rule or what other rule? - correct answer Birthday In what type of payment methodology is a lump sum or bundled payment negotiated between the payer and some or all providers? - correct answer Case rates What customer service improvements might improve the patient accounts department? - correct answer Ho...

Through what document does a hospital establish compliance standards? code of conduct What is the purpose OIG work plant? Identify Acceptable compliance programs in various provider setting If a Medicare patient is admitted on Friday, what services fall within the three-day DRG window rule? Non-diagnostic service provided on Tuesday through Friday What does a modifier allow a provider to do? Report a specific circumstance that affected a procedure or service without chan...

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...

Which of the following Medicare policies determines if a particular item or service is covered by Medicare? - CORRECT ANSWER National Coverage Determination (NCD) A patient's employer has not submitted a premium payment. Which of the following claim statuses should the provider receive from the third-party payer? - CORRECT ANSWER Denied A billing and coding specialist should routinely analyze which of the following to determine the number of outstanding claims? - CORRECT ANSWER Agin...

A set of standards that provides universal names and codes for laboratory and clinical results is . Answer - Logical Observation Identifiers Names and Codes (LOINC) High-quality information is contingent on . a. Computerized decision support b. Systems integration c. Knowledge management d. Reliable data Answer - d. Reliable data The individual most likely to lead strategic planning for a healthcare organization's information system is the . a. CEO b. HIM director c. CIO d. Medical ...

1-day payment window rule - Answer a Medicare requirement similar to the day payment window rule that applies to inpatient poychiatric hosp tals, inpatient rehabilitation facilities, long term care facilities, and chil dren's and cancer hospital. 3-day payment window rule - Answer a Medicare requirement that all diagnostic and clinically related non-diagnostic outpatient services provided with in three days of an inpatient admission must combined the inpa- tient claim when they are provided ...

CRCR EXAM WITH CORRECT CHOICES, CERTIFIED AND VERRIFIED What are collection agency fees based on? - CORRECT ANSWER-A percentage of dollars collected Self-funded benefit plans may choose to coordinate benefits using the gender rule or what other rule? - CORRECT ANSWER-Birthday In what type of payment methodology is a lump sum or bundled payment negotiated between the payer and some or all providers? - CORRECT ANSWER-Case rates What customer service improvements might improve the patie...

NR 509 Final Exam (Latest Practice Questions) Question: The function of the auditory ossicles is to:  transmit the light reflex to the light cone.  transform sound vibrations into mechanical waves for the inner ear.  to capture sound waves from the external ear for transmission into the middle ear.  to separate the inner ear from the middle ear. Question 1: A primary care NP is developing a clinical practice guideline for management of a patient population in a midsized subu...

Medicare Health insurance for those over age 65, people under 65 with certain disabilities & those with ESRD (end stage renal disease - permanent kidney failure requiring dialysis or kidney transplant) CMS Centers for Medicare and Medicaid Services administers the Medicare program. Social Security Administration handles most of the enrollment & plays a role in claims appeal process. MAC Medicare Administrative Contractor - company contracted to administer Part A & Part B claims....

HFMA: Healthcare Financial Management Association Exam (2024 / 2025) Questions and Verified Answers 1. Which of the following options is an alternative to valid long-term payment plans? ~ Answer: Bank loans 2. What type of plan restricts benefits for nonemergency care to approved providers only? ~ Answer: A PPO (preferred provider organization) plan 3. What does scheduling allow provider staff to do? ~ Answer: Review the appropriateness of the service requested 4. When an adult patient is covere...