Managed care plans hmo - Study guides, Class notes & Summaries

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

Solution and Answer Guide for: Blesi, Medical Assisting, 2022; 9780357502815; Chapter 01: The Medical Assistant, Health Care Team, and Medical Environment © 2022 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible 1 website, in whole or in part. Solution and Answer Guide for Medical Assisting Administrative & Clinical Competencies (MindTap Course List) 9th Edition by Michelle Blesi Blesi, Medical Assisting, 2022; 9780357502815; Chapt...

CSPR - Certified Specialist Payment Rep (HFMA) questions with correct answers 1. Steps used to control costs of managed care include :Answer: Bundled codes Capitation Payer and Provider to agree on reasonable payment 2. 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 3. Identify the various types of private health plan coverage:Answer: HMO Conven...

What Act shaped how commercial insurance carriers approached the concepts of paying for medical care? correct answer: HMO Act of 1973 ACA correct answer: Affordable Care Act HMO (Health Maintenance Organization) correct 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 correct answer: part of prospective payment in which healthcare p...

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

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

605 Midterm Question and answers correctly solved Managed Care - correct answer 1) acts as the insurance company and the providers of care. 2) Employs mechanisms to control (manage) utilization of medical services. 3) Determines the price at which the services are purchased and how much the providers get paid. 4) Is the most dominant health care delivery system in the United States and available to most Americans. This is includes both Health Maintenance Organizations (HMO) and Preferred Pr...

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 HDHP/SO plans - high-deductible health plans with a savings option; Private - Includ...

Providers - Are people or organizations that provide health care, including doctors, nurses, clinics, and agencies. facilities - are places where care is delivered or administered, including, hospitals, long-term care facilities or nursing homes, and treatment centers. Payers - people or organizations paying for healthcare services long term care (LTC) - facilities, also called "nursing homes," "skilled nursing facilities," and "extended care facilities" are for people who need 24...

Medical Billing and Coding Lesson 1: Reimbursement, HIPAA, and Compliance Already Passed The Medical Coder's Responsibility Each coding system plays a critical role in reimbursement. The role of the medical coder is to optimize payment while adhering to coding guidelines. The coder must accurately code the services, procedures, and diagnosis rendered so that the office is properly reimbursed. Coders may encounter ethical issues about upcoding a procedure or changing a diagnosis to ob...