Hmos - Study guides, Class notes & Summaries

Chapter 01: Caring for Medical-Surgical Patients deWit: Medical-Surgical Nursing: Concepts & Practice, 4th Edition MULTIPLE CHOICE 1. Which statement accurately describes the primary purpose of the state nurse practice act (NPA)? a. To test and license LPN/LVNs. b. To define the scope of LPN/LVN practice. c. To improve the quality of care provided by the LPN/LVN. d. To limit the LPN/LVN employment placement. ANS: B While improving quality of care provided by the LPN/LVN may be a result...

Maine Life Insurance Exam Questions With Complete Solutions. Contributory Health Insurance If the employees share a portion of the premium. Often require participation by 75% of eligible members. Noncontributory Health Insurance If the employer pays the entire premium. Most require 100% participation by eligible members. (Funding of Group Insurance) Shared funding Allows employer to self-fund health care expenses, select a deductible and pay covered expenses for any individual incurring ...

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...

Federal requirements - Answer-by means of the health maintenance act of 1973, Congress strongly supported the growth of health maintenance organizations in this country. The act force employers with more than 25 employees to offer HMO as an alternative to their regular health plans. (The part of the act requiring dual Choice has expired and has not been reenacted) The HMO provides benefits in the form of services rather than in the form of reimbursement for the services of the position or hos...

Certified Specialist Payment Rep (CSPR) HFMA 2024/25 Review-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...

NC Medicare, Medicaid & LTC Insurance Licensing Comprehensive Exam || All Questions & Answers (Rated A+)NC Medicare, Medicaid & LTC Insurance Licensing Comprehensive Exam || All Questions & Answers (Rated A+)NC Medicare, Medicaid & LTC Insurance Licensing Comprehensive Exam || All Questions & Answers (Rated A+)NC Medicare, Medicaid & LTC Insurance Licensing Comprehensive Exam || All Questions & Answers (Rated A+) Federal Program - ANSWER - Medicare is a federal health insurance program. Part of...

CNML Test Exam Questions Revised With Correct Answers < Updated & Already Passed > DRGs - ANSWER : Diagnostic-Related Groups: payment rate based on specific diagnoses Prospective Payment System - ANSWER : Used by Medicare-participating hospitals: pretreatment diagnosis billings based on DRGs; rate decided ahead of time between insurance companies and hospitals Exclusive Provider - ANSWER : Used by HMO's: insurance coverage for contracted providers or institutions ...

Medicare, Medic aide, LTC NC Insurance Exam Questions And Answers Federal Program - ANS Medicare is a federal health insurance program. Part of the Social Security program, Medicare is run by the Centers for Medicare & Medicaid Services of the Department of Health and Human Services. Private firms contract with the federal government to handle the paperwork, review claims, and disburse claim payments. Medicare Part A - ANS Designed primarily to provide hospital insurance and to pa...

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 ...

Medicare, Medicaide, LTC NC Insurance Exam Questions and Answers 100% CorrectMedicare, Medicaide, LTC NC Insurance Exam Questions and Answers 100% CorrectMedicare, Medicaide, LTC NC Insurance Exam Questions and Answers 100% CorrectMedicare, Medicaide, LTC NC Insurance Exam Questions and Answers 100% Correct Federal Program - ANSWER-Medicare is a federal health insurance program. Part of the Social Security program, Medicare is run by the Centers for Medicare & Medicaid Services of the Departmen...