Third party payer - Study guides, Class notes & Summaries

(ABN)Advanced beneficiary notice Ans: advanced notice that the patient may have to pay for lab testing that medicare will not cover. Insurance Ans: a way of reducing a person's exposure to risk of loss because another party (insurance company) assumes the risk. Reimbursement Ans: the compensation or repayment for healthcare services. First party Ans: the patient or the person responsible for the healthcare bill Second party Ans: the physician, hospital, clinic, nursing home, or oth...

NCCT NCMA Practice Test - Part 3 Questions and Answers a - Answer-A bed patient in a hospital is called a(n) __________. a. inpatient b. outpatient c. third party payer d. provider b - Answer-A person who represents either party of an insurance claim is the ___________. a. doctor b. adjuster c. provider d. subscriber b - Answer-A request for payment under an insurance contractor bond is called a(n) _____________________. a. insurance application b. claim c. dual choice request ...

In health care payment systems, ________ is a more recent method of paying an organization, in which the third party payer establishes the amount of money that will be paid for the delivery of a particular service before offering the services to the client a. Retrospective reimbursement b. Prospective reimbursement c. Health Maintenance Organization (HMO) d. Preferred Provider Organization (PPO) Correct Answer-b. Prospective reimbursement Which statements are true? Select all that apply C...

What Act shaped how commercial insurance carriers approached the concepts of paying for medical care? - ANSWER-HMO Act of 1973 ACA - ANSWER-Affordable Care Act HMO (Health Maintenance Organization) - ANSWER-The organization is both the insurer and provider of a set of defined services. Patients within this network must use an in-network provider for their services to be covered. Capitation Payment - ANSWER-part of prospective payment in which healthcare providers receive fixed monthly p...

NHA CBCS study guide Questions and Answers (2024 / 2025) (Verified Answers) When submitting claims, which of the following is the outcome if Block 13 is left blank? The third-party payer reimburses the patient, and the patient is responsible for reimbursing the provider Which of the following do physicians use to electronically submit claims? clearinghouse When billing a secondary insurance company, which block should the billing and coding specialist fill out on the CMS-1500 claim ...

NHA,CBCS Exam (New 2024/ 2025 Update) |Questions and Verified Answers| 100% Correct| A Grade QUESTION Which of the following formats are used to submit electronic claims to a third-party payer? Answer: 837 QUESTION Urine moved from the kidneys to the bladder through which of the following parts of the body? Answer: Ureters QUESTION As of April 1, 2014, what is the maximum number of diagnoses that can be reported on the CMS-1500 claim form before a further...

CMAA EXAM STUDY GUIDE QUESTIONS AND ANSWERS WITH COMPLETE SOLUTIONS 100% VERIFIED when should an MA assistant schedule a return appointment for a pt when pt checks out proper protocol when following up on nonpayment and of claims from third party payers notify the pt of the claim; contact third party payer

Healthcare reimbursement methodologies breakdown into two primary types: 1- Fee-For-Service, Reimbursement based on: •Services provided to the patient 1.Self-pay 2.Retrospective payment 3.Managed care 2. Episode-of-Care, Patient's condition/illness •A specified time period 1.Managed care - capitation 2.Global payment 3.Prospective payment Third party payer Entity other than the patient reimburses provider for services Fee-for-service reimbursement is payment in which providers receive pa...

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...

EDF 6557 Ethics Final Exam 2023 with 100% correct answers 1. Which of these is not one of the 10 sections of the BACB's Professional and Ethical Compliance Code for Behavior Analysts?: Ethical Responsibility to Supervisors 2. Code element 1.01 discusses reliance on scientific knowledge. Which of the following describes behavior adhering to this code element:: All of the above 3. On what sources should behavior analysts base their practices?: A and B 4. Amy spends extra time with her cli...