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CHFP Module 1 Certification Test Questions And Correct Answers
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CHFP Module 1 Certification Test Questions AndCorrect Answers
is an amount predetermined, paid by the patient before the insurer begins to pay for
services. Answer deductible
a percent of the insurance payment amount that is paid by the patient in addition to what
the insurer pays. Answer coinsurance
a set amount that a patient pays per visit. Answer copayment
It also includes payment for services that are not covered in the patient's benefit design
and also the amount for services balance billed by out-of-network providers. Payments
usually doesn't include premium sharing by the patient. Answer: 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. - Answer Cost (to
the patient)
The cost - both direct and indirect-to the provider to deliver healthcare services to
patients. Answer Costs to the provider
The amount that is payable to the provider-or reimbursable to the patient-for services
rendered. Answer Cost to the health plan/insurer
The cost of health benefits provided, premiums or claims paid. Answer Cost to the
employer
,Dollar amount charged by a provider for services rendered before any discount
negotiation. Charge may be different from amount paid. -Answer Charge
Total dollar amount that provider expects health plans/payers and patients to pay for
healthcare services -Answer Price
Organization that negotiates or sets the 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. - Answer Health
Plan/Payer
Entity, organization, or individual that furnishes a healthcare service. - Answer Provider
Occurs when a health care provider bills a patient for charges, other than copayments,
coinsurance or any amounts that may remain on the patient's annual deductible, in
excess of the health plan's payment for a covered service. In-network providers are
contractually precluded from balance billing health plan members, but balance billing
by out-of-network providers is common. - Answer Balance Billing
The information about the Price in Healthcare that, along with other information, defines
the value of services and enables patients and other care purchasers to identify,
compare, and choose providers that offer the desired level of value. Answer Price
Transparency
The quality of a healthcare service in relation to the total price paid for the service by
care purchasers. - Answer Value
flow of money between the patient, the insurer, and the provider of healthcare services
-Answer Revenue Cycle
function between a healthcare facility or physician and an insurer is one of the most
important resource management challenges in today's healthcare industry. -Answer
,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
receives payment, a determination of payment or a denial by the insurer. Today it is
more common to use the term payment. - Answer Reimbursement
The amount charged by a healthcare facility or physician for a specific service is termed
as - Answer Charges or Billed Charges
The charges of a healthcare facility or physician are a retail price and are usually
collected in a pricing list called - Answer Chargemaster
Fee-for-Service: A charge-based payment mechanism whereby a provider is paid either
list price (full charges) or a percentage of charges (full charges less a discount) for the
specific services rendered.
Fee-for-service payment provides what? More units of service in order to receive more
payments.
Why do Healthcare Facilities set Retail prices significantly above rates actually paid by
commercial insurers or the government? - Answer 1. Access to Contracted Payment
Rates.
Few not all insurers participate in provider networks that give them access to
contracted payment rates. Some auto insurers, liability insurers or companies providing
travel insurance to visitors from abroad still pay a provider's full charges.
2. Percent-of-Charge Contracts
-In relatively uncompetitive markets, percent-of-charge contracts are still used. The
greater the charge, the greater the percent-of-charge payment, unless the contract
caps a provider's annual price increases.
3. Outlier Provisions
, -Some insurance contacts include an outlier provision that gives providers an extra
payment-a fixed amount or a percent of actual charges exceeding a threshold-for
patients that are extremely ill and costly.
What is the use and benefits of Cost Based Payments? - Answer The only use of this
method today is in a limited set of small, rural healthcare facilities known as critical
access hospitals. This mechanism has seldom used for physicians. Cost-based payment
calls for the insurer to pay the healthcare provider based on the costs of providing
services, with a nominal allowance for margin.
What is the name of the Medicare program that was initiated with a payment
methodology to providers, which has now almost been phased out of the health-care
industry — - Answer Cost based Payment
Which of the following would benefit most from the cost-based payment method? -
Answer The health care provider
That's correct! Let's understand how it is.
This mechanism of payment is an advantage to the providers of health care, given the
assurance that all costs would be reimbursed, and there is no incentive to be efficient in
the delivery of care, since the costs are reimbursed by the insurance. Spurred by the
rapid escalation of U.S. healthcare costs subsequent to the inception of cost-based
payment in Medicare and Medicaid programs, development of the Prospective Payment
System was a means of paying acute care healthcare providers for inpatient services in
1983 and for outpatient services in 2000. Since that initial offering, CMS introduced
prospective payment systems for most other varieties of institutional health care
providers.
Cost-Based payment do reduced incentive for providers to be efficient.
Mountainside Health Plan is re-evaluating how it compensates hospitals across its
current service area. It seeks to decrease its per-patient costs and stabilize the total
cost of its payments to hospitals. Of the following methods of payment, which would it
find least effective in reaching those objectives? - Answer Cost-based payment
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