Hmo Study guides, Class notes & Summaries

AHIP 2025 Final Exam Questions and Answers (2024 / 2025) (Verified Answers).1. PPO, HMO, MSA, Cost Plan, PFFS ANS Types of Medicare Advantage Plans 2. Serve both Medicare and Medicaid individuals. Include Part D coverage. Individuals sometimes referred to as dual eligibles ANS Medicare-Medicaid plans 3. Type of Medicare health plan. Have Part B to enroll. Can join anytime plan is accepting new members. A non network provider will can charge higher coin- surances and deuctibles. Different enr...

What is an eligible building for flood insurance?: A structure with 2 or more outside rigid walls and a fully secure roof, built on a permanent site, with 50% or more of the value above ground level and located within an eligible community What is Builders Risk Coverage?: Covers buildings in the course of completion. Proper coverage is 100% of expected completed value Do all Homeowners policies contain Coverage A?: No, HO-4 (Renters person- al property) What is casual labor in workers' compen...

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 s...

FLORIDA 2-15 INSURANCE LICENSE EXAM ACTUAL UPDATE WITH LATEST ONLINE WRITTEN EXAM QUESTIONS AND ANSWERS NEW UPDATE Accumulation units are converted into annuity units: A group life insurance plan in which the employer pays the entire premium is known as a ________________ plan. If a disabled worker covered under Social Security disability benefits recovers and then is disabled again within five years, a new waiting period is required before benefits begin again. Robert had an accid...

CSPR - Certified Specialist Payment Rep (HFMA) Questions and Answers 2023 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 H...

TEST BANK OF ENDODONTICS PRINCIPLES AND PRACTICE 6th EDITION by Mahmoud Torabinejad and Ashraf F. Fouad 1.Which of the following is a condition that can be described as irreversible pathosis of the pulp: a.Dentin hypersensitivity b.Pulp canal obliteration (total calcification) c.Internal resorption d.Sharp, brief pain with thermal changes 2.The following inflammatory mediator(s) is/are not elevated in the pulp, in cases with symptomatic irreversible pulpitis: a.Prostaglandins b.Leuko...

ATI RN Maternal Newborn 1. A nurse is caring for a client who has uterine atony and is experiencing postpartum hemorrhage. Which of the following actions is the nurse’s priority? • Massage the client’s fundus Uterine atony and postpartum hmorrhage indicate that this client is at the greatest risk for hypovolemic shock. This can compromise the client’s vital organs, which can lead to death. Therefore, the nurse’s priority is to massage the client’s fundus to minimize blood loss. ...

Principles of Economics, 2nd Australian Edition, 2e Joseph Stiglitz, Carl Walsh, Jeffrey Gow, Ross Guest, William Richmond, Max Tani (Test Bank) Principles of Economics, 2nd Australian Edition, 2e Joseph Stiglitz, Carl Walsh, Jeffrey Gow, Ross Guest, William Richmond, Max Tani (Test Bank)

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...

Kentucky Life and Health Insurance Exam (New 2024/ 2025 Update) Questions and Verified Answers| 100 % Correct| Grade A QUESTION The only party in an insurance contract that makes a legally enforceable promise is the insurance company. Because of this, insurance contracts are considered to be: conditional aleatory unilateral contracts of adhesion Answer: unilateral Insurance contracts are unilateral. This means that only one party (the insurer) makes any kind of ...

Through what document does a hospital establish compliance standards? code of conduct What is the purpose OIG work plant? Identify Acceptable compliance programs in various provider setting If a Medicare patient is admitted on Friday, what services fall within the three-day DRG window rule? Non-diagnostic service provided on Tuesday through Friday What does a modifier allow a provider to do? Report a specific circumstance that affected a procedure or service without chan...