Out of pocket payments - Study guides, Class notes & Summaries

Commercial Real Estate SAE - Champion's School of Real Estate 495 Questions with Verified Answers Productivity Management - CORRECT ANSWER Measuring the results from the use of available systems and tools for prospecting activities CRM - CORRECT ANSWER Contact Relationship Manager, a tool used to automate prospecting tasks and manage leads Geographic farming - CORRECT ANSWER A particular area that may include neighborhoods that a sales agent or broker markets for the solicitation of bus...

H has suffered a covered disability away from her job and will shortly begin collecting benefits. The insurer sends a letter to H stating that she will not receive any benefit amounts greater than her income. This clause is known as: A: Over-insurance clause B: free look C: relation of earning to insurance D: relation of economic value - answer-C: relation of earning to insurance The insured should be aware of the issue date upon delivery a policy and the date should be listed on: A: the...

CSPR - Certified Specialist Payment Rep (HFMA) Questions and Answers 2023 Steps used to control costs of managed care include: Bundled codes Capitation Payer and Provider to agree on reasonable payment DRG is used to classify 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 HMO Conventional PPO and POS H...

Missouri Life and Health Exam Questions and Answers 100% Pass In a Life insurance contract, an insurance company's promise to pay stated benefits is called the: a) insuring clause b) consideration clause c) entire contract d) owner's rights insuring clause under which circumstance MUST a health insurer have an expedited grievance review procedure? when the enrollee's life or health is jeapordized The Consideration clause in a life insurance contract contains what pertinent information? ...

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...

When life insurance proceeds are used to pay inheritance taxes and federal estate taxes, it is known as - Answer- Estate conservation In group insurance, the primary purpose of the Coordination of Benefits provision is to - Answer- Prevent overinsurance Which of the following statements is NOT true regarding health insurance policy provisions? - Answer- All additional provisions written by insurers are cataloged by their respective states. The policyowner has an option to pledge the lif...

Steps used to control costs of managed care include: correct answers Bundled codes Capitation Payer and Provider to agree on reasonable payment DRG is used to classify correct answers 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 correct answers HMO Conventional PPO and POS HDHP/SO plans - high-deductible health...

Texas Life And Health Insurance Exam Questions With Correct Answers | Latest 2023/2024 (Graded A+). Which of the following actions is NOT possible with a Universal Life policy? - Correct Answer-Premiums may be applied as a credit against income tax Which of the following will a Long Term Care plan typically provide benefits for? - Correct Answer-home health care Which health policy clause stipulates that an insurance company must attach a copy of the application to the policy to ensure that...

Which of the following is true in regards to health care today in the United States? There are more primary care physicians than specialty physicians. Primary care receives a higher reimbursement in professional fees. There are more specialty physicians than primary physicians. Outpatient care is slowly decreasing. - ANSWER-There are more specialty physicians than primary physicians. What triggered the downsizing phase in the U.S. hospital industry during the 1980s? Hill-Burton Act Mana...

Healthcare Reimbursement -Study guide Questions and Answers Rated A+ How does the reimbursement process change when a patient visits out-of-network providers? When a patient visits an out-of-network provider, they often face higher out-of-pocket costs, and the provider may receive lower reimbursement rates or no direct payment from the insurance company. What happens when a claim is denied due to a lack of medical necessity? If a claim is denied for lacking medical necessity, the pr...

TEST FOR ADJUSTER PRO, FLORIDA STUDY(QUESTIONS AND ANSWERS)A+ GRADED EXAM 2023-2024 - CORRECT ANSWER-Subtract the deductible from covered damages to get indemnification - CORRECT ANSWER-6 unique characteristics of insurance policy 1 Contracts of adhesion (court ez win) 2 Utmost good faith 3 aleatory 4 personal 5 Unilateral (only insurer has obligation) 6 Conditional - CORRECT ANSWER-1945 regulate insurance Naic doesn't give benefits to comissioners 90 day to pay hijacking on...

What Act shaped how commercial insurance carriers approached the concepts of paying for medical care? - ANSWER-HMO Act of 1973 ACA - ANSWER-Affordable Care Act HMO (Health Maintenance Organization) - ANSWER-The organization is both the insurer and provider of a set of defined services. Patients within this network must use an in-network provider for their services to be covered. Capitation Payment - ANSWER-part of prospective payment in which healthcare providers receive fixed monthly p...