Third party payer - Study guides, Class notes & Summaries

Steps used to control costs of managed care include: - ANSWER-Bundled codes Capitation Payer and Provider to agree on reasonable payment DRG is used to classify - ANSWER-Inpatient admissions for the purpose of reimbursing hospitals for each case in a given category w/a negotiated fixed fee, regardless of the actual costs incurred Identify the various types of private health plan coverage - ANSWER-HMO Conventional PPO and POS HDHP/SO plans - high-deductible health plans with a savings...

CBCS Final Practice Test (NHA) 2024/2025 graded A+

NR 511 Week 1: Quiz1 The phrase usual and customary refers to: The success rate of a specified procedure. How much an insurer will charge to provide coverage. Correct Answer How charges for a service compares with charges made to other persons receiving similar services and supplies. How an insurer evaluates the need for an ordered diagnostic test. The phrase usual and customary refers to the comparison of charges with other like charges for services and supplies received in the imm...

Test Bank For Old's Maternal-Newborn Nursing and Women's Health Across the Lifespan, 11th Edition (Patricia Ladewig, 2024) | All Chapters Included | Complete Latest Guide A+. Chapter 1 : Contemporary Maternal-Newborn Nursing 1) The nurse is speaking to students about changes in maternalnewborn care. One change is that self-care has gained wide acceptance with clients and the healthcare community due to research findings that suggest that it has which effect? A) Shortens newborn length of ...

Which of the following Medicare policies determines if a particular item or service is covered by Medicare? - CORRECT ANSWER National Coverage Determination (NCD) A patient's employer has not submitted a premium payment. Which of the following claim statuses should the provider receive from the third-party payer? - CORRECT ANSWER Denied A billing and coding specialist should routinely analyze which of the following to determine the number of outstanding claims? - CORRECT ANSWER Agin...

how does the registration process begin in an outpatient setting? - ANS - when a new patient calls the office for an appointment to see a provider. what does a front staff member do once they obtain information from a new patient? - ANS - they create an account that includes the patient's identity, medical condition, and insurance/payment info. what does a front staff member do once they obtain information from an established patient? - ANS - the staff member searches for the patient reco...

Which of the following are subject to strike legal requirements? D. Records, regardless of format That part of the health record used for continuity of care is the _____ information. A. Clinical The legal health record is defined as that containing the _____. A. Complete and accurate description of the patient's history, condition, Inc. care provided Federal and state statutes (laws) that directly impact the quality of the health record include requirements about _____. ...

PTCB Exam Questions With Correct Answers Latest Update 2024 (100% Verified) Knowing which of the following can best assist a technician in the prevention of data entry errors? A. Names of medications B. Insurance co-payments C. Pharmacokinetics D. Physician contact information - Answer A. Names of medications Which of the following injectable drugs would be stored in refrigerator? A. Clindamycin B. Ciprofloxacin C. Cyanocobalamin D. Calcitonin-salmon - Answer D. Calcitonin-salmon The ...

Knowing which of the following can best assist a technician in the prevention of data entry errors? A. Names of medications B. Insurance co-payments C. Pharmacokinetics D. Physician contact information (Ans- A. Names of medications Which of the following injectable drugs would be stored in refrigerator? A. Clindamycin B. Ciprofloxacin C. Cyanocobalamin D. Calcitonin-salmon (Ans- D. Calcitonin-salmon The requirement that a non-formulary medication be covered only if approved...

PTCB EXAM 2024 WITH 100% ACCURATE SOLUTIONS Knowing which of the following can best assist a technician in the prevention of data entry errors? A. Names of medications B. Insurance co-payments C. Pharmacokinetics D. Physician contact information - correct answer A. Names of medications Which of the following injectable drugs would be stored in refrigerator? A. Clindamycin B. Ciprofloxacin C. Cyanocobalamin D. Calcitonin-salmon - correct answer D. Calcitonin-salmon The requ...