which of the following services is most likely to be considered medically necessary? - ️️standard of care for health condition
What is meant by the phrase point of service in point of service healthcare insurance plan? - ️️members chose the reimbursement model (HMO, PPO, fee for service) w...
which of the following services is most likely to be considered
medically necessary? - ✔ ✔ standard of care for health
condition
What is meant by the phrase point of service in point of service
healthcare insurance plan? - ✔ ✔ members chose the
reimbursement model (HMO, PPO, fee for service) when they
need healthcare services rather than during the open enrollment
period
In which type of healthcare payment does the healthcare plan
recompense providers with a fixed rate for each day a covered
member is hospitalized? - ✔ ✔ per diem
In which type of healthcare payment method does the healthcare
plan oversee both the costs of healthcare and the outcomes of
care? - ✔ ✔ Managed care
insurance policy providing benefits to a resident requiring home
care and services - ✔ ✔ long term care policies provide
benefits for nursing home care and services
insurance policy providing benefits to an insured who becomes
blind - ✔ ✔ accidental death and dismemberment loss
, policies-cover expenses due to an accident that causes a loss,
such as a death, amputation of a limb, or blindness
Integrated delivery systems use varying degrees of integration.
Which degree of integration is least binding? - ✔ ✔ affilliation
Medicare's payment system for home health services consolidates
all types of services, such as speech, physical, and occupational
therapy, into a single lump sum payment. What type of healthcare
payment method does this lump sum payment represent? - ✔
✔ global payment
Of the following types of MCOs, which one has the strictest
procedures for control of costs? - ✔ ✔ staff model
Phil White had a coronary artery bypass graft surgery.
Unfortunately, during the surgery, Phil suffered a severe stroke.
Phil's recovery included several settings in the continuum of care-
acute care hospital, physician office, rehabilitation center, and
home health agency. This initial service and subsequent recovery
lasted ten months. As a member of an MCO in an integrated
delivery system, how should Phil expect that his healthcare billing
will be handled? - ✔ ✔ He will be billed for one fixed amount
for the entire episode that is divided among all the physicians,
facilities and other healthcare providers
In which type of healthcare payment method does the healthcare
plan pay for each service that a provider renders? - ✔ ✔ fee-
for-service reimbursement
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