Capitation - Study guides, Class notes & Summaries

capitation correct answers payment to health care providers on the basis of the number of people covered instead of payment for the services provided. care mgmt correct answers the process of developing and managing the care of a patient or resident, focusing on the quality of care delivered. care planning correct answers the process of developing a plan of care for a patient or resident. CARF international correct answers an organization that accredits rehabilitation and human services...

Healthcare Reimbursement 4-2 Module Quiz 100% Pass What is the primary purpose of healthcare reimbursement? The primary purpose of healthcare reimbursement is to compensate healthcare providers for the services rendered to patients. What are the main types of healthcare reimbursement methods? The main types of healthcare reimbursement methods include fee-for-service, capitation, and bundled payments. How does the fee-for-service reimbursement model work? In the fee-for-serv...

Risk - answer-Risk is the uncertainty of loss Capitation - answer-Capitation payments are payments agreed upon in a capitated contract by a health insurance company and a medical provider. They are fixed, pre-arranged monthly payments received by a physician, clinic or hospital per patient enrolled in a health plan, or per capita. Under a health maintenance organization HMO service providers are paid a fixed monthly fee for each member. This concept is called - answer-Capitation When ca...

Certified Specialist Payment Rep (CSPR) HFMA 2024/25 Review-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...

Knowing which of the following can best assist a technician in the prevention of data entry errors? A. Names of medications B. Insurance co-payments C. Pharmacokinetics D. Physician contact information - correct answerA. Names of medications Which of the following injectable drugs would be stored in refrigerator? A. Clindamycin B. Ciprofloxacin C. Cyanocobalamin D. Calcitonin-salmon - correct answerD. Calcitonin-salmon The requirement that a non-formulary medication be covered ...

CSPR - Certified Specialist Payment Rep (HFMA) questions with correct answers 1. Steps used to control costs of managed care include :Answer: Bundled codes Capitation Payer and Provider to agree on reasonable payment 2. 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 3. Identify the various types of private health plan coverage:Answer: HMO Conven...

Management functions correct answers key functions of a manager including planning, organizing, staffing, directing & controlling Management connective processes correct answers mgmt functions that connect elements of the healthcare org. including communicating, coordinating and decision making Joint Commission correct answers primary accrediting organization for healthcare orgs. Healthcare Financial Mgmt Association (HFMA) correct answers Association of healthcare financial managers; c...

Retrospective Pay v. Prospective Pay & Define DRGs - ANSWER*Retrospective*: - paid all bills sent to them without looking at them until they were already paid - paid for unnecessary charges & doctor's errors - hospitals were reimbursed for all costs *Prospective*: - payment for hospital services to Medicare pts was based on a flat fee per admission based on the Diagnostic Related Groups (DRGs) - "you can bill us for this service but we have a flat fee per service and we won't ...

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 ...

HTHRHSC 3400 EXAM 2 QUESTIONS AND ANSWERS ALREADY PASSED What are the key components of a health care system? The key components of a health care system include health care providers, patients, financing mechanisms, and health policies. What role does health policy play in health care delivery? Health policy plays a critical role in shaping how health care is delivered, influencing access, quality, and cost of care. What is the significance of health care financing? Health care fi...