Medical necessity - Study guides, Class notes & Summaries

Healthcare Reimbursement Chapters 8+ Latest Version Already Passed How do insurance plans typically categorize services for reimbursement? Insurance plans categorize services based on various criteria such as type of care, urgency, and medical necessity, influencing the coverage and reimbursement rates. What role does the Medicare Severity Diagnosis Related Groups (MS-DRGs) play in reimbursement? MS-DRGs classify hospital cases into groups that are expected to have similar hospi...

Patient Centric Revenue Cycle This includes all the major processing steps required to process a pt account from the request for service through closing the account with a zero balance and purging it from the system pre-service this is the period in which scheduling and pre-access takes place, including different steps that will be completed pre-service what is it when the requested service is screened for medical necessity, health plan coverage & benefits are verified, and pre-...

Healthcare Reimbursement -Study guide Questions and Answers Rated A+ How does the reimbursement process change when a patient visits out-of-network providers? When a patient visits an out-of-network provider, they often face higher out-of-pocket costs, and the provider may receive lower reimbursement rates or no direct payment from the insurance company. What happens when a claim is denied due to a lack of medical necessity? If a claim is denied for lacking medical necessity, the pr...

1. A financial counselor/Financial Assistance: In accordance with Section 501(r) regulations through the Affordable Care Act, a hospital must establish a written financial assistance policy and make it available to patients. 2. Batch Processing: Execution of a series of jobs in a computer program without manual intervention; it is used to help maximize the use of computer resources and stabilize response time by performing system-intensive work during hours when users are less likely to require...

Reimbursement Methodologies Questions and Answers Already Passed What factors influence the development of reimbursement methodologies in healthcare? Factors influencing reimbursement methodologies include healthcare costs, the need for efficiency, regulatory changes, and advancements in medical technology. How do payer contracts impact healthcare provider reimbursement? Payer contracts outline the terms and conditions for reimbursement, including rates, covered services, and billin...

The term used to indicate that the service or procedure is reasonable and necessary for the diagnosis or treatment of illness or injury consistent with generally accepted standards of care is 1. appropriateness. 2. evidence-based medicine. 3. benchmarking. 4. medical necessity. (Ans- 4. medical necessity. Use the following table to answer the question. (See the word file) This information is the numerical identification of the service or supply. Each item has a unique number with a...

True or False: The ACA requires that all providers adopt a compliance plan as a condition of enrollment with Medicare, Medicaid, and Children's Health Insurance Program (CHIP). - Answer-True ref. ACA section 6102 According to HHS-OIG - what are three important reasons for proper documentation in Compliance? (hint: protections) - Answer-1.Protect our programs 2.Protect your patients 3.Protect the Provider At which level of the Medicare Part A or Part B appeals process is the appea...

An insurance adjustor requests a patient's progress notes following a motor vehicle crash. Which of the following should guide the EHR specialist in releasing this information? A. meaningful use B. continuity of care C. assignment of benefits D. minimum necessity - Answer-D. minimum necessity Which of the following is a feature of clinical decision support? A. allows patients access to educational material B. allows patient care to be tailored to published guidelines C. allows for...

Which of the following cell structures is the source of energy for a cell? - correct answer mitochondria A medical assistant is testing a patients visual acuity using a snellen chart. Which of the following actions should the assistant take? - correct answer Make sure the patient does not lean forward during the test Which of the following items included on the CMS-1500 claim form should a medical assistant recognize as indicating the medical necessity of a procedure? - correct answer Diag...

Origin: Chapter 1, 1 1. The nurse providing family-centered care in a hospital setting reflects on the focus of the health care provided in today's society. Which statement best describes the current definition of health? A) Health is described as 'an absence of disease.' B) Health is measured by monitoring mortality and morbidity of a group. C) Health is a state of complete physical, mental, and social well-being. D) Technological gains made in health care are shared equally among all...