Per diem rates - Study guides, Class notes & Summaries

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...

LAT Final Exam Questions and Answers Already Passed _______ ________ is the most frequently used laboratory animal in behavioral research and ________ _________ are also frequently used in this type of research. a) Mus musculus; Mesocricetus auratus b) Meriones unguiculatus; Cavia porcellus c) Rattus norvegicus; Columba livia d) Macaca mulatta; Oryctolagus cuniculus C ___________ is the science of poisons and the harmful or noxious effects these substances have on living organism...

Calculate the following amounts for a participating provider who bills Medicare: Submitted charge (based on provider's regular fee for office visit) $ 75 Medicare physician fee schedule (PFS) $ 60 Coinsurance amount (paid by patient or supplemental insurance) $ 12 Medicare payment (80 percent of the allowed amount) $ ????? Medicare write-off (not to be paid by Medicare or the beneficiary) $ ????? correct answer: Medicare payment (80 percent of the allowed amount) $48 Medicare write-...

HADM 3311 6-12 Latest 2023 Already Passed Adverse selection Enrollment in greater numbers by high-risk individuals Premiums rise for everyone, making health insurance less affordable unless healthy individuals are mandated to buy health insurance Beneficiary the insured Benefits services covered by an insurance plan(medically necessary) specified in a contract dental coverage is often separate Capitation Per member per month(PMPM) fee to cover all needed services Monthly fee=PMPM rate x numbe...

mortgage Broker - Answer- Functions as a middleman between the borrower and the lender, negotiating, selling or arranging loans to be delivered to large investors Mortgage Banker - Answer- Provide their own funds for the purpose of providing mortgage financing Correspondent Lender - Answer- Smaller in scale then mortgage bankers or brokers, these lenders typically extended loans with their own funds at their own risk Origination - Answer- The process of creating a new mortgage loan U...

Revenue Management Exam Q&A Solution Update 2023 Patients who are assigned the same DRG have all of the following comparable criteria, except: A.Diagnosis code B.Healthcare protocol C.Length of stay D.Utilization management - ANS->>C.Length of stay Joe Patient was admitted to Community Hospital. two days later, he was transferred to big Medical Center for further evaluation and treatment. He was discharged to home after three days. Community Hospital will receive from Medicare...

Revenue Management Exam 2023 Questions and Answers Complete Patients who are assigned the same DRG have all of the following comparable criteria, except: A.Diagnosis code B.Healthcare protocol C.Length of stay D.Utilization management C.Length of stay Joe Patient was admitted to Community Hospital. two days later, he was transferred to big Medical Center for further evaluation and treatment. He was discharged to home after three days. Community Hospital will receive from Medicare: A.Th...

Contribution Margin - correct answer Difference between marginal revenue and marginal cost. Break-even point - correct answer Level of sales volume of a product producing the exact amount of contribution margin needed to cover fixed costs. Overhead - correct answer Indirect Costs Activity-based costing (ABC) - correct answer Method of determining product costs using cost drivers or activity measures, which cause indirect costs to be incurred. Three main types of Cost standards. - cor...

There are 3 parties in healthcare reimbursement. Who is the second party? Provider of care or services All of the following methods are types of episode-of-care reimbursement EXCEPT: Self-insured plan Which of the three models for health systems predominates in the United States? Private health insurance model Payers that use per-diem payment rates reimburse the provider a fixed rate for each day a covered member is hospitalized. True A patient sees an orthopedic physician for treatment of a...

Revenue Management Exam 2023 Questions and Answers Complete Patients who are assigned the same DRG have all of the following comparable criteria, except: A.Diagnosis code B.Healthcare protocol C.Length of stay D.Utilization management C.Length of stay Joe Patient was admitted to Community Hospital. two days later, he was transferred to big Medical Center for further evaluation and treatment. He was discharged to home after three days. Community Hospital will receive from Medicare: A.Th...