Capitation fee Study guides, Class notes & Summaries

HADM 3311 6-12 Latest 2023 Already Passed Adverse selection Enrollment in greater numbers by high-risk individuals Premiums rise for everyone, making health insurance less affordable unless healthy individuals are mandated to buy health insurance Beneficiary the insured Benefits services covered by an insurance plan(medically necessary) specified in a contract dental coverage is often separate Capitation Per member per month(PMPM) fee to cover all needed services Monthly fee=PMPM rate x numbe...

Complete Solutions Manual for Government and Not-for-Profit Accounting: Concepts and Practices, 9th Edition 9e by Michael H. Granof, Saleha B. Khumawala, Thad D. Calabrese. ISBN-13: 3898 1 The Government and Not- for- Profit Environment 1 How Do Governments and Not- For- Profits Compare With Businesses? 2 In Practice: Why Is State And Local Government Accounting Important? 6 What Other Characteristics of Governments and Not- For- Profits Have Accounting Implications? 9 How Do Governments Compare...

Legal Issues for COMLEX Level 1 Questions and Answers Already Passed A fellow physician is smelling of alcohol on the job. What do you do? Report him to state medical board and inform chief of staff, etc. A female is pregnant and she confides in the physician that the baby is NOT her husbands. The husband is also a patient of yours, but she request that you not tell her husband. What should the physician do? Do *NOT* tell the husband -Also, do NOT encourage the patient in any way -Le...

MHA 706 MIDTERM- LORD EXAM | QUESTIONS & 100% CORRECT ANSWERS (VERIFIED) | LATEST UPDATE | GRADEA+ Proprietorships & Partnerships: Pros & Cons Correct Answer: Pros: Ease of Information, Subject to a few regulations, no corporation income taxes. Cons: Limited life, difficult to transfer, unlimited life, difficult to raise capital. Corporations: Pros & Cons Correct Answer: Pros: Unlimited life, easy transfer of ownership, limited liability, ease of raising capital. Cons: Cost of for...

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...

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...

CPQA - ANSWER-certified professional in quality assurance When did CPHQ begin to advance the profession of quality and when was the first certification administered? - ANSWER-1976; Sept 8 1984 Board of Director's Quality Role - ANSWER-1. set policy 2. financial and strategic direction 3. quality of care 4. goals and objectives 5. establish quality priorities Leadership - ANSWER-ability to influence an individual or group toward achievement of a goal and includes determining the ...

CSPR - Certified Specialist Payment Rep (HFMA) 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 ...

Proprietorships & Partnerships: Pros & Cons - CORRECT ANSWER-Pros: Ease of Information, Subject to a few regulations, no corporation income taxes. Cons: Limited life, difficult to transfer, unlimited life, difficult to raise capital. Corporations: Pros & Cons - CORRECT ANSWER-Pros: Unlimited life, easy transfer of ownership, limited liability, ease of raising capital. Cons: Cost of formation and reporting, double or triple taxes must be paid. Non-profit Organization - CORRECT ANSWER-Exempt...

MHA 706 Midterm- Lord Exam Questions and Answers 100% Pass Proprietorships & Partnerships: Pros & Cons - Correct Answer ️️ -Pros: Ease of Information, Subject to a few regulations, no corporation income taxes. Cons: Limited life, difficult to transfer, unlimited life, difficult to raise capital. Corporations: Pros & Cons - Correct Answer ️️ -Pros: Unlimited life, easy transfer of ownership, limited liability, ease of raising capital. Cons: Cost of formation and reporting, double o...