Hmo pos - Study guides, Class notes & Summaries

Legal Contract - Consideration, Legal Purpose, Offer (Made by Insured), Acceptance, Competent Parties A commissioner must give how many days advance notice of a hearing? - 21 Days (Guaranteed Association) Maximum benefits for any one life- Life insurance cash values - $100,000 (Guaranteed Association) Maximum benefits for any one life- Life insurance death benefits - $300,000 (Guaranteed Association) Maximum benefits for any one life- Other health insurance benefits - $100,000 (Guarante...

UHC CERTIFICATION EXAM 2024 WITH 100% CORRECT ANSWERS Joseph has Original Medicare and was a patient in the hospital last week. What part of Medicare helps cover the costs of his inpatient hospital stay? - correct answer Part A - correct answer The consumer must be in a valid MA election or disenrollment period. Which of the following consumers would be eligible for Medicare? - correct answer Consumers age 65 or older, consumers under 65 years of age with certain disabilities for mor...

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) - answer-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...

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 - Include...

CPMSM Study Guide Questions and Answers Fully solved 2024 Non-profit under religious/community control. Voluntary/Charitable Hospital Non-profit under city, state, county. Govt (non-federal) hospital Brainpower Read More Previous Play Next Rewind 10 seconds Move forward 10 seconds Unmute 0:07 / 0:15 Full screen Owned/operated by fed gov't, supported by fed funds, e.g., VA. Under direct supervision of Surgeon General. Govt (federal) hospital Owned by corpor...

UHC CERTIFICATION EXAM 2024 WITH 100% CORRECT ANSWERS Joseph has Original Medicare and was a patient in the hospital last week. What part of Medicare helps cover the costs of his inpatient hospital stay? - correct answer Part A - correct answer The consumer must be in a valid MA election or disenrollment period. Which of the following consumers would be eligible for Medicare? - correct answer Consumers age 65 or older, consumers under 65 years of age with certain disabilities for mo...

©BRAINBARTER 2024/2025 Georgia Adjuster Exam Questions With 100% Verified Answers. Liaison - answercommunication or cooperation which facilitates a close working relationship between people or organizations. exemplary - answerideal model, representing the best fiduciary - answertrust, representation for a principal-contractor or insurance company Residual market (shared market) - answerauto insurance market serves drivers at high risk that are denied coverage by insurers 3 residual mar...

CSPR - Certified Specialist Payment Rep (HFMA) Exam 2024 With Correct Solutions 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 Conve...

AHIP Final Examination Questions and Answers (2024 / 2025) (Verified Answers).1. 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 ANS 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, f...

CSPR - CERTIFIED SPECIALIST PAYMENT REP (HFMA) EXAM WITH ANSWERS GRADED A+ 1. Steps used to control costs of managed care include: Bundled codes Capitation Payer and Provider to agree on reasonable pay- ment 2. DRG is used to classify Inpatient admissions for the purpose of reimburs- ing 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 4. Managed care organi-...