Capitated payment method - Study guides, Class notes & Summaries

RHIA Domain 4 Practice Exam Questions and Answers All Correct The process in which a healthcare entity addresses the provider documentation issues of legibility, completeness, clarity, consistency, and precision is called: a. Query process b. Release of information process c. Coding process d. Case-finding process - Answer-A Healthcare entities should consider a policy in which queries may be appropriate when documentation in the patient record fails to meet one of the following five cri...

AHIMA Reimbursement Methodology Questions and Answers Already Graded A The financial manager of the physician group practice explained that the healthcare insurance company would be reimbursing the practice for its treatment of the exacerbation of congestive heart failure that Mrs. Zale experienced. The exacerbation, treatment, and resolution covered approximately five weeks. The payment covered *All The Services That Mrs. Zale Incurred During The Period*. What method of reimbursement...

RHIA 2024 Test Questions with Revised Answers When is a physician query not appropriate - Answer-a query may not be appropriate when the clinical information or clinical picture does not appear to support the documentation of a condition or procedure. in situations in which healthcare entity's policies can provide guidance on a process for addressing the issue without querying the attending physician. What is clustering - Answer-practice of coding or charging one or two middle levels of ser...

Calculate the amount of money a patient would owe for a noncovered service costing $900 if their indemnity policy has a coinsurance rate of 80-20, and they have already met their deductible correct answers $900 Calculate the monthly capitation payment a provider should receive from a health plan if they have 80 contracted patients and a capitated payment of $40 per month correct answers The monthly capitation payment would total $3,200 (80 x $40 = $3,200). A capitated payment amount is cal...

ACO - Accountable Care Organization (pg. 18) - ACCURATE ANSWERS are primary care-led physician and hospital organizations that voluntarily form networks ACA - Affordable Care Act (pg. 17) - ACCURATE ANSWERS consists of the PPACA and the Health Care and Education Reconciliation Act of 2010 Allowable Charge (pg. 10) - ACCURATE ANSWERS represents the maximum or average amount the third-party will reimburse for the providers services Bad Debt (pg. 16) - ACCURATE ANSWERS are services for whi...

CCA Exam Prep Domain 2 (2023/2024) Rated A+ Allowable fee Average or maximum amount the third-party payer will reimburse providers for the service Block grant It is a fixed amount of money given or allocated for a specific purpose. Ex. Medicare's payment system for home health services are consolidated into the single payment Capitated payment method It is a method of payment for health services in which the thirdparty payer reimburses providers a fixed, per capita amount for a period. "...

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...

WGU C425 Final Exam Questions With 100% Verified Answers | Latest Update 2023/2024. What Is Health? - ANSWER--U.S. health care has followed a medical/biomedical model. - It assumes illness or disease thereby emphasizing clinical diagnosis and medical in the treatment of disease or its symptoms. - It emphasizes • Clinical diagnosis and medical interventions to: - Treat disease or its symptoms. - Have a clinical diagnosis and medical interventions. Largely governed by the medical model/...

HSC 111 Final Exam - Questions and Answers (Complete Solutions) What is the central role of health services financing in the United States? a. Fund health insurance b. Underwrite medical risk c. Support managed care d. Balance the supply of health care professionals What is the primary mechanism that enables people to obtain health care services? a. Availability of services b. Health insurance c. Payment for services d. Control of expenditures The phenomenon called 'moral hazard' results dir...

Healthcare Reimbursement Final Exam Fall 2023 with verified solutions There are 3 parties in healthcare reimbursement. Who is the first party? Patient or guarantor Which type of reimbursement methodology is associated with the abbreviation "PMPM"? Capitated payment What is an example of a charge that usually would be reviewed by an HIM coder? Claim is failing due to potentially incomplete code, including missing modifiers. Which of the following coding systems was created for reportin...