BUNDLE OF RHIA Domain 4 ExamS with Questions and Correct Answers Verified Solutions

Using the information provided, if the physician is a non-PAR who accepts assignment, how much can they expect to be reimbursed by Medicare? Physician's normal charge = $340 Medicare fee schedule = $300 Patient has met their deductible A. $228 B. $240 C. $285 D. $300 - Answer A. $228

what is the limiting charge amount? - Answer 115 The limiting charge does not apply to: (3) - Answer immunizations, supplies, or ambulance services Two main types of coverage plans in Medicare - Answer fee-for-service or managed care The Medicare fee-for-service plan - Answer Original Medicare P...

The conversion factor is the national dollar multiplier that sets the allowance for the relative values—a constant (Casto and Forrestal 2013, 157). A Joint Commission accredited organization must review their formulary annually to ensure a medications continued: - Answer efficacy and safety Pa...

What is the term for the set fee that a policyholder or certificate holder must periodically pay a health insurance plan in return for healthcare coverage? - Answer Premium All of the following occurrences are considered "qualifying life events" except: - Answer Car accident All of the follow...

Types of HMOs - Answer Group model HMO, independent practice association, network model HMO, staff model HMO PFFS - Answer You can see any doctor, other healthcare providers, or hospitals as long as they agree to treat you. The plan determines how much it will pay for services received SNP - An...

In the APC system, a high-cost outlier payment is paid when which of the following occurs? a. The cost of the service is greater than the APC payment by a fixed ratio and exceeds the APC payment plus a threshold amount. b. The LOS is greater than expected. c. The charges for the services provid...