Third party payer - Study guides, Class notes & Summaries

Chapter 1, 2, & 3 Healthcare reimbursement Questions and Answers Already Passed What factors determine the payment rates for different medical procedures? Payment rates for medical procedures are determined by factors such as the complexity of the service, the geographic location of the provider, and the established payer guidelines. How does electronic health record (EHR) usage affect healthcare reimbursement? EHR usage can streamline the billing process, improve accuracy in co...

MNT II: Billing And Coding Questions And Answers 2024/2025 Solutions Health care provider or supplier agrees (or is required by law to accept the third party payer-approved amount as full payment for covered services and not to bill the client for any more than the deductible and coinsurance. ANS Accept Assignment A group of care providers who give coordinate care and chronic disease management, and thereby improve the quality of care patients get. The organization's payment is tied to a...

ethics branch of philosophy applied ethics practical applications of moral standard laws binding rules determined by authority medical ethics moral conduct to regulate behavior of medical professionals beneficence principles of doing good veil of ignorance justice-based three-step ethics model Kenneth Blanchard and Norman Vincent Peale's approach to ethics R/O rule out a diagnosis gut feeling decision based on emotion A problem that occurs when using a duty-bas...

NHA CBCS Exam Pep (New 2024/ 2025) | Questions and Verified Answers| 100% Correct| A Grade QUESTION What are three major kinds of government insurance plans? Answer: Medicare, Medicaid and children's health insurance program (SCHIP) QUESTION What is the difference between RA and EOB? Answer: RA=sent to the provider's office from the third-party payer. EOB=sent to the policyholder. QUESTION What is an allowable charge? Answer: The amount the he...

ARRT MRI mock registry exam practice questions and answers A patient arrives at the imaging facility with a crainal scar. The technologist should: A. wrap the head in a sterile dressing B. perform the MRI procedure immediately to document the patient's surgical history C. ignore the scar, it doesn't matter if the patient has had cranial surgery, as long as we are scanning another part of the patient's body D. screen the patient, their doctor, and/or family member to find...

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 answerA. Names of medications Which of the following injectable drugs would be stored in refrigerator? A. Clindamycin B. Ciprofloxacin C. Cyanocobalamin D. Calcitonin-salmon - correct answerD. Calcitonin-salmon The requirement that a non-formulary medication be covered ...

CRCR EXAM WITH CORRECT CHOICES, CERTIFIED AND VERRIFIED What are collection agency fees based on? - CORRECT ANSWER-A percentage of dollars collected Self-funded benefit plans may choose to coordinate benefits using the gender rule or what other rule? - CORRECT ANSWER-Birthday In what type of payment methodology is a lump sum or bundled payment negotiated between the payer and some or all providers? - CORRECT ANSWER-Case rates What customer service improvements might improve the patie...

Management functions correct answers key functions of a manager including planning, organizing, staffing, directing & controlling Management connective processes correct answers mgmt functions that connect elements of the healthcare org. including communicating, coordinating and decision making Joint Commission correct answers primary accrediting organization for healthcare orgs. Healthcare Financial Mgmt Association (HFMA) correct answers Association of healthcare financial managers; c...

Chapter 9 Reimbursement Questions and Answers Graded A+ How do third-party payers affect the healthcare reimbursement process? Third-party payers, such as insurance companies, facilitate payments to healthcare providers on behalf of patients, often based on pre-negotiated rates. Why is accurate medical coding essential in the reimbursement process? Accurate medical coding ensures that healthcare providers are properly reimbursed by translating diagnoses and procedures into codes t...

Abuse - Actions inconsistent with accepted, sound medical business or fiscal practice Accept Assignment - Provider accepts as payment in full whatever is paid on the cliam by the payer (except for any copayment and or coinsurance amounts.) Accounts Receivable - The amount owed to a business for services or goods provided. Accounts Receivable Aging Report - Shows the status (by date) of outstanding claims from each payer, as well as payments due from patients. Accounts Receivable Management -...