Prospective reimbursement - Study guides, Class notes & Summaries

TEST BANK : MEDICAL SURGICAL NURSING: CONCEPTS & PRACTICE 3RD EDITION BY deWit (CHAPTER 1-48)Chapter 01: Caring for Medical-Surgical Patients Chapter 02: Critical Thinking and the Nursing Process Chapter 03: Fluid, Electrolytes, Acid-Base Balance, and Intravenous Therapy Chapter 04: Care of Preoperative and Intraoperative Surgical Patients Chapter 05: Care of Postoperative Patients Chapter 06: Infection Prevention and Control Chapter 07: Care of Patients with Pain Chapter 08: Care of Patients wi...

Test Bank for Medical-Surgical Nursing 5E Holly Stromberg Chapter 01: Caring for Medical-Surgical Patients Stromberg: Medical-Surgical Nursing: Concepts and Practice, 5th Edition MULTIPLE CHOICE 1. Which statement accurately describes the primary purpose of the state nurse practice act (NPA)? a. To test and license LPN/LVNs b. To define the scope of LPN/LVN practice c. To improve the quality of care provided by the LPN/LVN d. To limit the LPN/LVN employment placement ANS: B While improv...

Which of the following is true in regards to health care today in the United States? There are more primary care physicians than specialty physicians. Primary care receives a higher reimbursement in professional fees. There are more specialty physicians than primary physicians. Outpatient care is slowly decreasing. -Correct Answer There are more specialty physicians than primary physicians. What triggered the downsizing phase in the U.S. hospital industry during the 1980s? Hill-Burton Ac...

According to the Code of Ethics, one way executives can avoid or minimize negative implications of conflict of interest is: a) develop a PR plan to address conflict of interest scenarios b) not participate in specific decisions where conflict may exist c) ensure members submit annual holdings for inspection d) make the conflict known to those in superior positions Correct Answer: D The principles of quality improvement require that executives change their management philosophy from: A...

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...

NY Series 17-52 Questions and Answers 100% Pass How many eligible employees must be included in a contributory health insurance plan? 50% A man works for Company A and his wife works for Company B. The spouses are covered by health plans through their respective companies that also cover the other spouse. If the husband files a claim, The insurance through his company is primary. What is the period of coverage for events such as death or divorce under COBRA? 36 months Twenty-five days after ...

Which of the following is true in regards to health care today in the United States? There are more primary care physicians than specialty physicians. Primary care receives a higher reimbursement in professional fees. There are more specialty physicians than primary physicians. Outpatient care is slowly decreasing. - ANSWER-There are more specialty physicians than primary physicians. What triggered the downsizing phase in the U.S. hospital industry during the 1980s? Hill-Burton Act Mana...

CON 170 Fundamentals of Cost and Price Analysis MIDTERM EXAM_2023. 1. Which of the following statements most closely summarizes government pricing objectives? b. Acquire goods and services from responsible sources at fair and reasonable prices. 2. As a contract specialist, you should be aware that: a) Different sellers in the same market may have different pricing objectives and approaches. b) Sellers in different markets often have different approaches to contract pricing. c) A single fir...

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...

Healthcare Reimbursement Methodologies Chapter 1: Questions and Answers 100% Pass What is healthcare reimbursement? Healthcare reimbursement is the process by which healthcare providers receive payment for the medical services they provide to patients. How do healthcare reimbursement methodologies affect patient care? Reimbursement methodologies influence how providers deliver care by creating incentives for specific types of services or treatments and by affecting the cost t...

Reimbursement Methodologies » Healthcare Reimbursement Questions and Answers Already Passed How does reimbursement methodology affect healthcare provider behavior? Reimbursement methodologies incentivize healthcare providers to manage costs, deliver efficient care, and focus on patient outcomes, depending on the specific model in place. What is the impact of diagnosis-related groups (DRGs) on hospital reimbursement? DRGs determine the amount hospitals will be reimbursed based on ...

Healthcare Reimbursement Final Exam Questions and Answers Already Passed What is the difference between direct and indirect costs in healthcare? Direct costs are expenses directly tied to patient care, such as salaries and medical supplies, while indirect costs are overhead expenses, like administrative salaries and utilities. What role do diagnosis-related groups (DRGs) play in reimbursement? DRGs categorize hospital cases into groups that determine the fixed payment amount for i...