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CHFP Module 1 Certification Test Exam Question And Answers 2024
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CHFP Module 1 Certification Test ExamQuestion And Answers 2024
is a pre-determined amount that the patient pays before
the insurer begins to pay for services - correct
answers✅deductible
a percentage of the insurance payment amount that is
paid by the patient, along with the amount paid by the
insurer. - correct answers✅coinsurance
a flat amount that the patient pays at each time of
service - correct answers✅copayment
payment also includes amounts for services that are not
included in the patient's benefit design and amounts for
services balance billed by out-of-network providers.
Payments typically does not include premium sharing by
the patient. - correct answers✅Out-of-pocket payment
The amount payable out of pocket for healthcare
services, which may includes deductibles, copayments,
coinsurance, amounts payable by the patient for services
that are not included in the patient's benefit design, and
amounts "balance billed" by out-of-network providers.
Health insurance premiums constitute a separate
category of healthcare costs for patients, independent of
healthcare utilization. - correct answers✅Cost (to the
patient)
,CHFP Module 1 Certification Test Exam
Question And Answers 2024
The expense (direct and indirect) incurred to deliver
healthcare services to patients. - correct
answers✅Costs (to the provider)
The amount payable to the provider (or reimbursable to
the patient) for services rendered. - correct
answers✅Cost (to the health plan/insurer)
The expense related to provided health benefits
(premiums or claims paid) - correct answers✅Cost (to
the employer)
The dollar amount a provider sets for services rendered
before negotiating any discounts. The charge can be
different from the amount paid. - correct
answers✅Charge
The total amount a provider expects to be paid by health
plans/payers and patients for healthcare services. -
correct answers✅Price
An organization that negotiates or sets rates for provider
services, collects revenue through premium payments or
tax dollars, processes provider claims for service, and
pays provider claims using collected premium or tax
revenues. - correct answers✅Health Plan/Payer
,CHFP Module 1 Certification Test Exam
Question And Answers 2024
An entity, organization, or individual that furnishes a
healthcare service. - correct answers✅Provider
Occurs when a healthcare provider bills a patient for
charges (other than copayments, coinsurance or any
amounts that may remain on the patient's annual
deductible) that exceed the health plan's payment for a
covered service. In-network providers are contractually
prohibited from balance billing health plan members, but
balance billing by out-of-network providers is common. -
correct answers✅Balance Billing
In healthcare, readily available information on the price of
healthcare services that, together with other information,
helps define the value of those services and enables
patients and other care purchasers to identify, compare
and choose providers that offer the desired level of value
- correct answers✅Price Transparency
The quality of a healthcare service in relation to the total
price paid for the service by care purchasers. - correct
answers✅Value
the flow of money between the patient, the insurer, and
the provider of healthcare services - correct
answers✅Revenue Cycle
, CHFP Module 1 Certification Test Exam
Question And Answers 2024
function between a healthcare facility or physician and an
insurer is one of the most important resource
management challenges in today's healthcare industry. -
correct answers✅Billing and Collection
An older term used to describe payment by an insurer to
a healthcare facility or physician. This term is used
because a physician or healthcare facility provider render
services to a patient and then submits claims a claim to
an insurer. The healthcare facility or physician waits for
processing of that claim by the insurer, and ultimately
recieves payment, a determination of payment or a
denial by the insurer. Today it is more common to use the
term payment. - correct answers✅Reimbursement
The price set by a healthcare facility or physician for their
services is referred to as - correct answers✅Charges or
Billed Charges
The charges by a healthcare facility or physician
represent the retail price and are usually compiled in a
price listing known as - correct
answers✅Chargemaster
a charge-based payment mechanism in which a provider
is paid either list price (full charges) or a percentage of
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