Payers Study guides, Class notes & Summaries

Which of the following are subject to strike legal requirements? D. Records, regardless of format That part of the health record used for continuity of care is the _____ information. A. Clinical The legal health record is defined as that containing the _____. A. Complete and accurate description of the patient's history, condition, Inc. care provided Federal and state statutes (laws) that directly impact the quality of the health record include requirements about _____. ...

NRNP 6675-15; NRNP 6675 Week 6 Midterm Exam 2022 100% solved -Graded A+   NRNP 6675-15; NRNP 6675 Week 6 Midterm Exam 2022 100% solved -Graded A+ 1. Which of the following are risk factors for neuroleptic malignant syndrome? Select all that apply Age Rapid dose escalation Parental route of administration Higher potency typical antipsychotics 2. Antipsychotic medications provide D2 blockade in the mesocortical pathway causing which of the following effects? Reduces negative symptoms Increases e...

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 and POS HDHP/SO plans - high-deductible health plans with a savings...

HOSA Physical Therapy Questions and Answers Graded A When was the ADA signed into law? July 26th, 1990 What is the term for action requiring significant difficulty or expense taking into consideration direct and net cost of accomodations, the facitilies financial resources, number of persons employed and impact of operations. Undue Hardship What is the term for an employer excluding a qualified individual from employment if they pose a direct threat to the health and safety of oth...

MIdterm for Ethics EDF 6557 EXAM 2023 with 100% correct answers 1. 1.04 Practicing within a Defined Role: provide services only after defining and documenting their professional role with relevant parties in writing. 2. Scope of practice: Defined at the level of the profession-The range of activities in which members of a profession may be authorized to engage in by virtue of holding a credential or license-The range of activities might be defined by a credentialing body, certifying agency...

Which of the following statements are true of HFMA's Patient Financial Communications Best Practices? - Answer- The best practices were developed specifically to help patients understand the cost of services, their individual insurance benefits, and their responsibility for balances after insurance, if any. The patient experience includes all of the following except: - Answer- Recognition that revenue cycle processes must be patient-centric and efficient. This is especially true in the areas...

Third-party payers that interact directly with retail pharmacies include: correct answers - Pharmacy benefit managers - Medicare prescription drug plans - Medicare advantage plans with prescription drug benefits - Medicaid Which are mechanisms used by third-party payers to control prescription costs and control utilization? correct answers - Prior authorization - Step therapy - Generic substitution - Quantity limits - Formularies Define formulary correct answers List of medications ...

HPA 210 Complete Study Questions And Answers With Verified Solutions What do taxes also pay for screenings mitigation of community health hazards primary payment sources for the US's _________ annual health care bill $2.9 trillion annual health care bill. Investment this category consists of research, structures and equipment Other Payers this category comprises worksite health care, workers' compensation, vocational rehabilitation, Indian Health Services, and maternal and child health.

Drug formularies: - help manufacturers determine which drugs are efficacious. -help salesmen determine what to sell -determine which drugs will be covered by third-party payers -Answers b. and c. are correct. - Correct Answer--determine which drugs will be covered by third-party payers In North America it is typical for physicians to work in hospitals but not be employed by them. This is a form of: -vertical integration - horizontal integration -incomplete horizontal integration -in...

PCT Certification exam Correct 100% Providers - ANSWER people or organizations that provide health care (doctors, nurses, clinics, agencies Facilities - ANSWER places where care is delivered or administered Payers - ANSWER people or organizations paying for healthcare services (insurance companies, govt programs medicaid, medicare, and the individual person needing care) Long-Term Care (LTC) - ANSWER need 24 hr skilled care Skilled care - ANSWER medically-necessary care given by...