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

Indiana Navigator Exam Questions and Answers Already Passed Auto Assignment the process by which an individual who does not select a Hoosier Healthwise (HHW) or HIP Managed Care Entity (MCE) at the time of the HHW or HIP application, or within 14 days of the submission of the application, is automatically assigned to a Managed Care Entity (MCE) Certificate of Coverage a list of benefits, services, cost sharing, exclusions, and limits applied by a particular health insurance policy. ...

A business offers a group disability income plan and pays the premiums. If an employee suffers a disabling injury, the benefits paid to the employee will be: - Answer-axable income to the business deductible income to the employee a deductible business expense for the business taxable income to the employee A business overhead expense policy does NOT provide: - Answer-tax-free benefits a Medicare SELECT plan is - Answer-a managed care policy. A Medicare SELECT plan is a - Answer-managed c...

Legal Contract - Consideration, Legal Purpose, Offer (Made by Insured), Acceptance, Competent Parties A commissioner must give how many days advance notice of a hearing? - 21 Days (Guaranteed Association) Maximum benefits for any one life- Life insurance cash values - $100,000 (Guaranteed Association) Maximum benefits for any one life- Life insurance death benefits - $300,000 (Guaranteed Association) Maximum benefits for any one life- Other health insurance benefits - $100,000 (Guarante...

CSPR - Certified Specialist Payment Rep (HFMA) Graded A+ 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...

Fun facts : - the oldest form of managed care is the health maintenance organization (HMO) - According to fortune magazine analysis of industries, managed care had the highest growth rate of the five major healthcare sectors - ACA mandates that health insurance companies must spend 80-85% of their premium revenues on quality health care Managed Care organizations : - control who the consumer sees and how much the service cost - became well established in the health care system when H...

CSPR - Certified Specialist Payment Rep (HFMA) Review Test 2024. 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 an...

CSPR - Certified Specialist Payment Rep (HFMA) Review Test 2024. 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 an...

Revenue Cycle Management Final 100% Correct Review Test 2023 Update enter an X in both the Medicare and Medicaid boxes of Block 1 - ANS-When completing a CMS-1500 claim for Medicare-Medicaid (Medi-Medi) crossover claims: a. enter an X in both the Medicare and Medicaid boxes of Block 1 b. enter MCD followed by the patient's Medicaid ID number in Block 10b c. enter MEDIGAP in Block 9a d. complete two claims, one each for Medicare and Medicaid E/M services - ANS-Major revisions to CPT...

A health plan can best be defined as an organization that Integrates the delivery and financing of healthcare and seeks to manage healthcare cost, access, and quality The earliest versions of heath plans appeared in 1910 What is not an early form of health plan Preferred provider organization Which is a provision of the HMO act of 1973 Federally qualified HMOs were exempted from some state laws For an HMO which was not an advantage of federal qualification The HMO did not have to meet c...

Medical billing and coding latest version graded A+ Medical Insurance Financial plan (the payer) that covers the cost of hospital and medical care Policyholder Person who buys an insurance plan; the insured, subscriber, or guarantor Health Plan Individual or group plan that provides or pays for the cost of medical care Benefits What a health plan pays for services covered in an insurance policy; listed in the schedule of benefits. Medical Necessity Reasonable services of prov...