Hmo pos - Study guides, Class notes & Summaries

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...

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-deductible health plans with a savings option; Private - Includ...

CSPR - Certified Specialist Payment Rep (HFMA) Questions with Correct Answers | Graded A+ 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 PP...

Which type of MA Plan is an HMO plan that also covers certain benefits out-of-network, generally at a higher cost? -Medicare Supplement Insurance Plan -Point-of-Service (POS) Plan -Preferred Provider Organization (PPO) -Private Fee-for-Service (PFFS) ️ Point-of-Service (POS) Plan 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? His enrollment in Medicare Parts A and B is general...

Nevada Life and Health License Exam Prep Questions Latest Update Graded A+ What are the four required elements of an insurance contract? Agreement, consideration, competent parties, and legal purpose. What two parts make up a life insurance application? 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? At the time of appl...

Joe and Mary are a married couple and both carry insurance from their employers. Joe was born on February 23, 1977 and Mary was born on April 4, 1974. Using the birthday rule, who carries the primary insurance for their children for billing? A. Joe, because he is the male head of the household. B. Mary, because her date of birth is the 4th and Joe's date of birth is the 23rd. C. Mary, because her birth year is before Joe's birth year. D. Joe, because his birth month and day are before...

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 plan. Mr. Polanski likes the cost of an HMO ...

CSPR - Certified Specialist Payment Rep (HFMA) Graded A+ 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...

CSPR - Certified Specialist Payment Rep (HFMA) Review Test 2024. 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 an...

CSPR - Certified Specialist Payment Rep (HFMA) Review Test 2024. 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 an...