Out of pocket payment - Study guides, Class notes & Summaries

H has suffered a covered disability away from her job and will shortly begin collecting benefits. The insurer sends a letter to H stating that she will not receive any benefit amounts greater than her income. This clause is known as: A: Over-insurance clause B: free look C: relation of earning to insurance D: relation of economic value - answer-C: relation of earning to insurance The insured should be aware of the issue date upon delivery a policy and the date should be listed on: A: the...

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...

TEST FOR ADJUSTER PRO, FLORIDA STUDY(QUESTIONS AND ANSWERS)A+ GRADED EXAM 2023-2024 - CORRECT ANSWER-Subtract the deductible from covered damages to get indemnification - CORRECT ANSWER-6 unique characteristics of insurance policy 1 Contracts of adhesion (court ez win) 2 Utmost good faith 3 aleatory 4 personal 5 Unilateral (only insurer has obligation) 6 Conditional - CORRECT ANSWER-1945 regulate insurance Naic doesn't give benefits to comissioners 90 day to pay hijacking on...

Reimbursement Methodologies Exam 3 Questions and Answers Already Passed What does "reimbursement methodology" refer to in healthcare? a. The process of hiring healthcare providers b. The system used to determine how healthcare providers are paid for services rendered c. The coding systems for diagnoses d. The administrative tasks involved in patient care How do managed care organizations typically influence reimbursement? a. By negotiating payment rates and controlling healthcare c...

Commercial Real Estate SAE - Champion's School of Real Estate 495 Questions with Verified Answers Productivity Management - CORRECT ANSWER Measuring the results from the use of available systems and tools for prospecting activities CRM - CORRECT ANSWER Contact Relationship Manager, a tool used to automate prospecting tasks and manage leads Geographic farming - CORRECT ANSWER A particular area that may include neighborhoods that a sales agent or broker markets for the solicitation of bu...

is a pre-determined amount that the patient pays before the insurer begins to pay for services - ANSWERdeductible a percentage of the insurance payment amount that is paid by the patient, along with the amount paid by the insurer. - ANSWERcoinsurance a flat amount that the patient pays at each time of service - ANSWERcopayment payment also includes amounts for services that are not included in the patient's benefit design and amounts for services balance billed by out-of-network provid...

CSPR - Certified Specialist Payment Rep (HFMA) questions with correct answers 1. Steps used to control costs of managed care include :Answer: Bundled codes Capitation Payer and Provider to agree on reasonable payment 2. 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 3. Identify the various types of private health plan coverage:Answer: HMO Conven...

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...

Wise Test Vocabulary Study Guide Rated A+ A fixed annual amount that an insured person must cover before their insurance company pays out a claim is called: Annual Deductible. This is the yearly amount or percentage that the insured must pay out-of- pocket, which the insurer will subtract from the claim payment. An insurance program designed for individuals who cannot secure auto insurance due to poor driving records, requiring them to obtain coverage at elevated rates through a s...

is a pre-determined amount that the patient pays before the insurer begins to pay for services - deductible a percentage of the insurance payment amount that is paid by the patient, along with the amount paid by the insurer. - coinsurance a flat amount that the patient pays at each time of service - copayment payment also includes amounts for services that are not included in the patient's benefit design and amounts for services balance billed by out-of-network providers. Payments typical...