Retrospective rating - Study guides, Class notes & Summaries

Quality Bonus Payments - TO make quality of care a priority the Affordable Care Act set a requirement that CMS make quality bonus payments to Medicare Advantage plans that earn four or more stars in a five-star quality rating system would receive a bonus payment. Earning fewer than four stars would receive no bonus. Suspect Logic - Many organizations utilize a method such as this one to uncover diagnoses which are likely present but unreported or unknown Chart Reviews - Analysis of the inf...

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...

UNDERWRITING - ANSWER classifies the applicant based upon the underwriting requirements INSURABLE INTEREST - ANSWER an economic interest in a property that must exist at the time of loss (you can insure the equity interest in your own home) of the insurer; matches the risk presented with the premium charged by the insurer LOSS RATIO - ANSWER percentage of claims paid in comparison to total premiums collected during a particular period of time RATES - ANSWER set by the insurer at a level...

HSC 111 Final Exam Questions and Correct Answers, With Complete Solution 2024. What is the central role of health services financing in the United States? a. Fund health insurance b. Underwrite medical risk c. Support managed care d. Balance the supply of health care professionals a. Fund health insurance What is the primary mechanism that enables people to obtain health care services? a. Availability of services b. Health insurance c. Payment for services d. Control of expenditures...

One distinguishing feature between independent agency systems and other marketing systems is the... - Answer-agency expiration list Foreign Insurer - Answer-An insurer licensed to operate in a state but incorporated in another state Domestic Insurer - Answer-An insurer doing business in the jurisdiction in which it was incorporated Alien Insurer - Answer-An insurer domiciled in a country other than the US Direct Response Marketing System - Answer-Greatly reduces compensation costs but has h...

Idaho Property and Casualty Comprehensive Exam 2024 Any financial interest in life or property such that, if the life or property were lost or harmed, the insured would suffer financially. Express Interest Insurable Interest Implied Interest Real Interest - Insurable Interest What are the 3 elements of insurable risk? Financial, Business, Loss Blood, Loss, Interest Financial, Blood, Business Business, Blood, Body - Financial, Blood, Business When must insurable interest exis...

Property Insurance - correct answer 2 party contract. Casualty Insurance - correct answer 3rd party contract. Liability. Insurable Interest - correct answer Financial someone has in someone or something. Required for coverage. Must exist AT THE TIME OF LOSS. Underwriting - correct answer Gathers information. Issue policy, decide on rates, fees and credits, may change coverage in order to issue, may reject a policy completely. GOAL = avoid adverse selection. Rates - correct answer Obj...

Florida Claims Adjuster Exam| Questions and Answers| Verified Solutions| 2023/ 2024 Update Q: The Nuclear Energy Liability Exclusion endorsement, in general, __________ all hazards related to nuclear energy. A. Includes B. Excludes C. Prohibits D. Summarizes Answer: B. Excludes Firms involved in Nuclear activities receive protection from special insurer pools organized for that purpose. Q: Toxic wastes escaped from a gas station disposal tank. The insured operator discovers th...

Insurable Interest correct answer: Stand to suffer an economic loss - follows ownership! Has to be known when loss occurs Underwriting correct answer: Underwriters function is to evaluate risks - reviewing the application. Risk selection process Formula for Loss Ratio? correct answer: Loss Ratio = Incurred Losses + Loss Adjusting Expense / Earned Premium Rates correct answer: Amount charged Class Rates correct answer: All applicants based on certain characteristics: Same, age, s...

Property & Casualty Insurance Basics Correct Questions & Answers! INSURABLE INTEREST - ANSWER an economic interest in a property that must exist at the time of loss (you can insure the equity interest in your own home) UNDERWRITING - ANSWER classifies the applicant based upon the underwriting requirements of the insurer; matches the risk presented with the premium charged by the insurer LOSS RATIO - ANSWER percentage of claims paid in comparison to total premiums collected during a partic...