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Nurs 8024 pharmacology exam 2 study guide questions and answers[with 246 questions
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Nurs 8024 pharmacology exam 2 study guidequestions and answers[with 246 questions
90. MSP (Medicare Secondary Payer) rules allow providers to bill Medicare for liability
claims after what happens? - ✔✔ANSW✔✔..120 days passes, but the claim then be
withdrawn from the liability carrier
Access - ✔✔ANSW✔✔..An individual's ability to obtain medical services on a timely and
financially acceptable level
According to the Department of Health and Human Services guidelines, what is NOT
considered income? - ✔✔ANSW✔✔..Sale of property, house, or car
Administrative Services Only (ASO) - ✔✔ANSW✔✔..Usually contracted administrative
services to a self-insured health plan
an increase in the dollars aged greater than 90 days from date of service indicate what
about accounts - ✔✔ANSW✔✔..They are not being processed in a timely manner
At the end of each shift, what must happen to cash, checks, and credit card transaction
documents? - ✔✔ANSW✔✔..They must be balanced
Care purchaser - ✔✔ANSW✔✔..Individual or entity that contributes to the purchase of
healthcare services
Case management - ✔✔ANSW✔✔..The process whereby all health-related
components of a case are managed by a designated health professional. Intended to
ensure continuity of healthcare accessibility and services
Charge - ✔✔ANSW✔✔..The dollar amount a provider sets for services rendered before
negotiating any discounts. The charge can be different from the amount paid
Claim - ✔✔ANSW✔✔..A demand by an insured person for the benefits provided by the
group contract
Collecting patient liability dollars after service leads to what? - ✔✔ANSW✔✔..Lower
accounts receivable levels
, Coordination of benefits (COB) - ✔✔ANSW✔✔..a typical insurance provision that
determines the responsibility for primary payment when the patient is covered by more
than one employer-sponsored health benefit program
Cost - ✔✔ANSW✔✔..The definition of cost varies by party incurring the expense
Coverage rules for Medicare beneficiaries receiving skilled nursing care require that the
beneficiary has received what? - ✔✔ANSW✔✔..Medically necessary inpatient hospital
services for at least 3 consecutive days before the skilled nursing care admission
Discounted fee-for-service - ✔✔ANSW✔✔..A reimbursement methodology whereby a
provider agrees to provide service on a fee for service basis, but the fees are
discounted by certain packages
Eligibility - ✔✔ANSW✔✔..Patient status regarding coverage for healthcare insurance
benefits
ESRD - ✔✔ANSW✔✔..End-stage renal disease. The patient has permanent kidney
failure, is covered by a GHP, and has not yet completed the 30-month coordination
period
Every patient who is new to the healthcare provider must be offered what? -
✔✔ANSW✔✔..A printed copy of the provider's privacy notice
FERA - ✔✔ANSW✔✔..Fraud Enforcement and Recovery act
First dollar coverage - ✔✔ANSW✔✔..A healthcare insurance policy that has no
deductible and covers the first dollar of an insured's expenses
Gatekeeping - ✔✔ANSW✔✔..A concept wherein the primary care physician provides all
primary patient care and coordinates all diagnostic testing and specialty referrals
required for a patient's medical care
Health plan - ✔✔ANSW✔✔..an insurance company that provides for the delivery or
payment of healthcare services
How are disputes with nongovernmental payers resolved? - ✔✔ANSW✔✔..Appeal
conditions specified in the individual payer's contract
how are HCPCS codes and the appropriate modifiers used? - ✔✔ANSW✔✔..To report
the level 1, 2, or 3 code that correctly describes the service provided
How are patient reminder calls used? - ✔✔ANSW✔✔..To make sure the patient follows
the prep instructions and arrives at the scheduled time for service
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