Third party payers are - Study guides, Class notes & Summaries

NHA,CBCS | Questions and Verified Answers| 100% Correct| Grade A (2024/ 2025 Update) Q: A beneficiary of a Medicare/Medicaid crossover claim submitted by a participating provider is responsible for which of the following percentages? Answer: 0% Q: Which of the following coding manuals is used primarily to identify products, supplies, and services? Answer: HCPCS level II manual Q: A billing and coding specialist needs to know how much Medicare paid on a claim before b...

NR511/ NR 511 Midterm Exam: Differential Diagnosis & Primary Care | Questions and Verified Answers| 100% Correct |Grade A (Latest 2024/ 2025 Update) – Chamberlain Q: Wellness services, eye exams, hearing exams, hearing aides, glasses Answer: Part C Medicare Q: Prescription drugs Answer: Part D Medicare Q: NP's are reimbursed at _______of the physician fee Answer: 85% Q: what is the purpose of medicare advantage plans Answer: lower co payments ...

PTCB EXAM TEST BANK QUESTIONS AND ANSWERS LATEST WITH RATIONALE Multiple choice What is the route of administration for a prescription with the following directions: "i supp pr q 6 hr prn"? A. Orally B. Rectally C. Urethrally D. Vaginall {{Correct Ans- B. Rectally Rationale: "pr" means per rectum. What is the meaning of PDA? A. Personal digital aid B. Personal digital assistant C. Physician digital assistant D. Pharmaceutical data assistant {{Correct Ans- B. Personal dig...

Third-party payers that interact directly with retail pharmacies include: correct answers - Pharmacy benefit managers - Medicare prescription drug plans - Medicare advantage plans with prescription drug benefits - Medicaid Which are mechanisms used by third-party payers to control prescription costs and control utilization? correct answers - Prior authorization - Step therapy - Generic substitution - Quantity limits - Formularies Define formulary correct answers List of medications ...

Healthcare Reimbursement Chapter 1 Review Quiz with Complete Solutions How do value-based reimbursement models differ from traditional models? Value-based reimbursement models focus on the quality of care and patient outcomes rather than the quantity of services provided, incentivizing providers to improve care delivery. What factors can lead to claim denials in the reimbursement process? Common factors that lead to claim denials include incomplete documentation, incorrect coding,...

Which of the following statements are true of HFMA's Patient Financial Communications Best Practices? - Answer- The best practices were developed specifically to help patients understand the cost of services, their individual insurance benefits, and their responsibility for balances after insurance, if any. The patient experience includes all of the following except: - Answer- Recognition that revenue cycle processes must be patient-centric and efficient. This is especially true in the areas...

NVCC RAD 105 Midterm Exam Questions with Correct A Define primal stresses - Answer-fundamental stress (original stress) that create certain innate responses Name primal stresses - Answer-fight or flight obtaining food death methods of obtaining food - Answer-persuasion bartering searching producing psychological needs - Answer-emotionality objectivity physiological needs - Answer-nutrition sleep recreation exercise no stress psychological and physiologic needs that effect le...

Drug formularies: - help manufacturers determine which drugs are efficacious. -help salesmen determine what to sell -determine which drugs will be covered by third-party payers -Answers b. and c. are correct. -determine which drugs will be covered by third-party payers In North America it is typical for physicians to work in hospitals but not be employed by them. This is a form of: -vertical integration - horizontal integration -incomplete horizontal integration -incomplete vertical i...

NRNP 6675-15; NRNP 6675 Week 6 Midterm Exam 2022 100% solved -Graded A+   NRNP 6675-15; NRNP 6675 Week 6 Midterm Exam 2022 100% solved -Graded A+ 1. Which of the following are risk factors for neuroleptic malignant syndrome? Select all that apply Age Rapid dose escalation Parental route of administration Higher potency typical antipsychotics 2. Antipsychotic medications provide D2 blockade in the mesocortical pathway causing which of the following effects? Reduces negative symptoms Increases e...

HCM Exit Test Questions & Answers 2024/2025 Which of the following is NOT a classical insurance principle? - ANSWERSThe possibility of moral hazard must exist Why do physicians like PPOs? - ANSWERSThere is more control over cost __________ is often identified as the factor most responsible for demand pull inflation in medical care. - ANSWERSThe presence of third party payers Who provides most long-term care services? - ANSWERS(Informal) Family caregivers or (Formal) CNA's A cos...