Primary payer - Study guides, Class notes & Summaries

HIM 2430 -- Principles of Healthcare Reimbursement FINAL Exam with Complete Solutions How do diagnosis-related groups (DRGs) affect hospital reimbursement? Diagnosis-related groups categorize hospital cases into groups that are expected to have similar hospital resource use, impacting how hospitals are reimbursed based on patient diagnoses. What is the impact of the Affordable Care Act on healthcare reimbursement models? The Affordable Care Act expanded access to insurance, promo...

1-day payment window rule - Answer a Medicare requirement similar to the day payment window rule that applies to inpatient poychiatric hosp tals, inpatient rehabilitation facilities, long term care facilities, and chil dren's and cancer hospital. 3-day payment window rule - Answer a Medicare requirement that all diagnostic and clinically related non-diagnostic outpatient services provided with in three days of an inpatient admission must combined the inpa- tient claim when they are provided ...

HFMA: Healthcare Financial Management Association Exam (2024 / 2025) Questions and Verified Answers 1. Which of the following options is an alternative to valid long-term payment plans? ~ Answer: Bank loans 2. What type of plan restricts benefits for nonemergency care to approved providers only? ~ Answer: A PPO (preferred provider organization) plan 3. What does scheduling allow provider staff to do? ~ Answer: Review the appropriateness of the service requested 4. When an adult patient is covere...

Medicare - Answer-Health insurance for those over age 65, people under 65 with certain disabilities & those with ESRD (end stage renal disease - permanent kidney failure requiring dialysis or kidney transplant) CMS - Answer-Centers for Medicare and Medicaid Services administers the Medicare program. Social Security Administration handles most of the enrollment & plays a role in claims appeal process. MAC - Answer-Medicare Administrative Contractor - company contracted to administer Part A &...

NHA CBCS Guide (2024/ 2025 Update) Exam | Questions and Verified Answers| 100% Correct| Grade A Q: What is the location method in reference to the CPT book? Answer: Procedure or service Just anatomic site Condition or disease Synonym, eponym, or abbreviation Q: What is the Stark Law? Answer: Prohibits a physician from referring patients for certain designated health services (Medicare & Medicaid) to entities with whom the physician has a financial relationship Q...

Healthcare Reimbursement 2 Questions and Answers Already Passed What is the role of the Centers for Medicare and Medicaid Services (CMS) in healthcare reimbursement? The Centers for Medicare and Medicaid Services (CMS) administers federal healthcare programs, sets reimbursement rates, and develops regulations that affect how providers are paid. How do diagnosis-related groups (DRGs) function in inpatient reimbursement? Diagnosis-related groups (DRGs) are a classification system ...

In health care payment systems, ________ is a more recent method of paying an organization, in which the third party payer establishes the amount of money that will be paid for the delivery of a particular service before offering the services to the client a. Retrospective reimbursement b. Prospective reimbursement c. Health Maintenance Organization (HMO) d. Preferred Provider Organization (PPO) Correct Answer-b. Prospective reimbursement Which statements are true? Select all that apply C...

Innovation and Challenge of the Patient-Centered Medical Home Model || With 100% Accurate Solutions Innovation and Challenge of the Patient-Centered Medical Home Model || With 100% Accurate Solutions Defining the Medical Home - ANSWER - Approach to primary care that is: -person-centered (supports patients & families in managing decisions and care plans) -Comprehensive (whole-person care provided by a team) -Committed to Quality and Safety (maximizes use of health IT, decision support & o...

LSUS MHA 706 Midterm Questions and Answers Graded A+ Question: What is the primary goal of healthcare financial management? Answer: The primary goal of healthcare financial management is to ensure that healthcare organizations have the financial resources to provide high-quality patient care, sustain operations, and achieve strategic objectives while maintaining financial stability. Question: How does cost-shifting impact healthcare providers? Answer: Cost-shifting occurs when hea...

NC Medicare Supplement & Long Term Care Insurance Licensing Exam Questions and Answers 100% Pass Medicare - Correct Answer ️️ -Health insurance for those over age 65, people under 65 with certain disabilities & those with ESRD (end stage renal disease - permanent kidney failure requiring dialysis or kidney transplant) CMS - Correct Answer ️️ -Centers for Medicare and Medicaid Services administers the Medicare program. Social Security Administration handles most of the enrollment &...