Capitation a Study guides, Class notes & Summaries

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...

Comlex Ethics Level 2 Exam 2024 (Verified Answers) What is respondeat superior or vicarious liability? - ANSWER it is when an employer is responsible for the actions of their employees. Both terms essentially mean the same thing. what is res ipsa loquitur? - ANSWER it is when a physician acts negligently to lead to an accident. the thing speaks for itself Example is if a physician prescribes the wrong medication leading to injury or leaves a scalpel inside someone . What is contributory...

Florida State Health Insurance Test with Certified Solutions neighbor An individual may purchase a life insurance policy on all of the following persons EXCEPT: a)dependent b)spouse c) business partner d) neighbor preexisting condition regarding long term care insurance, the existence of symptoms that would cause an ordinarily prudent person to seek diagnosis or treatment, or a condition for which medical advice or treatment was recommended by or received from a provider of health care serv...

CNML Test Exam Questions Revised With Correct Answers < Updated & Already Passed > DRGs - ANSWER : Diagnostic-Related Groups: payment rate based on specific diagnoses Prospective Payment System - ANSWER : Used by Medicare-participating hospitals: pretreatment diagnosis billings based on DRGs; rate decided ahead of time between insurance companies and hospitals Exclusive Provider - ANSWER : Used by HMO's: insurance coverage for contracted providers or institutions ...

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 informationAnswer - A. Names of medications Which of the following injectable drugs would be stored in refrigerator? A. Clindamycin B. Ciprofloxacin C. Cyanocobalamin D. Calcitonin-salmonAnswer - D. Calcitonin-salmon The requirement that a non-formulary medication be covered only if approv...

Risk correct answers Risk is the uncertainty of loss Capitation correct answers 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 correct answers ...

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...

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...

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...

What is respondent superior or vicarious liability? - ️️it is when an employer is responsible for the actions of their employees. Both terms essentially mean the same thing. what is res ipsa loquitur? - ️️it is when a physician acts negligently to lead to an accident. the thing speaks for itself Example is if a physician prescribes the wrong medication leading to injury or leaves a scalpel inside someone . What is contributory negligence? - ️️it is when a patient voluntar...