Medicare statutes Study guides, Class notes & Summaries

Medicare Statutes, Rules, and Regulations Pertaining to Medicare Supplement and Long-term Care Exam Questions & Answers..docx

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...

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...

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...

WGU C426 Healthcare Values and Ethics Rated A+ Normative Ethics Attempt to determine what moral standards should be followed so that human behavior and conduct may be morally right. Consequential Ethics Theory of ethics emphasizes that the morally right action is whatever action leads to the maximum balance of good over evil. - What will be the effects of each course of action? - Will they be positive or negative? - Who will benefit? - What will do the least harm? Utilitarian Ethics The conce...

NP Role Final Exam 159 Questions with Verified Answers In which specialty are most nurse practitioners educated? Peds Primary care Family Adult gerontology - CORRECT ANSWER primary care Which factor represents a potential barrier to Nurse Practitioner's practice in a primary care setting? Cost effectiveness Professional growth Aging baby boomers Collaboration agreements - CORRECT ANSWER Collaboration agreements Distinguish among the advanced practice registered nursing (APRN...

MEDICARE STATUTES, RULES, AND REGULATIONS PERTAINING TO MEDICARE SUPPLEMENT AND LONG-TERM CARE QUESTIONS AND ANSWERS

Which of the following individuals is an appropriate customer for a Medicare supplement policy? - ANSWER Someone enrolled in both Part A and Part B of Medicare An insurer may exclude coverage for a preexisting condition on a Medicare Supplement policy for up to - ANSWER 6 months An insured has a LTC policy that has been in force for 3 months. In how many more months will the policy become incontestable on the grounds of misrepresentation alone? - ANSWER 21 months Every agent soliciting ...

Nurse Practitioner Core Competencies all nurse practitioners upon graduation are expected to meet these. These include scientific foundations, leadership, quality, practice inquiry, technology and information literacy, policy, health delivery system, ethics, and independent practice history of NP role the NP role was introduced in 1965 by Loretta Ford and Henry Silver, MD at the University of Colorado. They identified new roles in which experienced RNs with advanced education and skills...

Trends in Health Care Delivery Exam Questions and Answers 2024 Laws - Answer-Man-made, unique to the mores and attitudes of a people, and intended to bring order and justice to their society Three major sources of law - Answer-•Statutory law •Executive, administrative, regulatory law •Judicial law Statutory Law - Definition - Answer-•Laws written and enacted by legislative bodies •Violations are criminal offenses and are punishable by fines or imprisonment Statutory Law - Answ...