HFMA terms With Correct Solutions 2024

HFMA terms With Correct Solutions 2024 provider - general - Answer -A party rendering medical care such as a physician or hopsital facilities provider - Answer -Includes hospitals, skilled nursing facilities, assisted living facilities, home health agencies, and ambulatory centers professional provider - Answer -includes physicians, pharmacists, nurses, therapists, and allied health professionals primary care - Answer -primary care physicians are usually trained in family practice, general practice, general internal medicine, and pediatrics. Physicians serving in primary care roles usually treat common medical conditions or injuries, and often provide preventive health screenings. They are often viewed as serving as a coordinator of a patient's care, assessing a patient's condition, and treating if a simple condition, or referring a patient to a specialist physician. specialist - Answer -specialists normally do not provide primary care services, instead focusing their work based on in-depth training in different diseases, body systems or types of health care service third party payer - Answer -a health insurance plan paying for the services out-of-pocket-payment - Answer -payments by patients that can be required as a part of a health insurance plan are: deductible, copayment, and coinsurance deductible - Answer -the deductible is a pre-determined amount that the patient pays before the insurer begins to pay for service coinsurance - Answer -corinsurance is a percentage of the insurance payment amount that is paid by the patient, along with the amount paid by the insurerer indemnify - Answer -payment on behalf of the patient - costs covered under the insurance contract between the patient and the insurer claim - Answer -a bill for services provided pre-authroization - Answer -permission by the insurer to render services to the patient before actually treating the patient. This includes verification of payment for the service by the insurer benefit payment - Answer -once the insurer has determined the claim is appropriate, a payment is made to the provider. This payment is officially termed a benefit payment beneficiary - Answer -insurers usually refer to the patient for which services are paid as the beneficiarya covered benefit - Answer -the services for which the insurer will pay are usually referred to as a covered benefit denial - Answer -the insurer may determine that the claim from the provider is not a covered benefit and will not pay the claim to the provider remittance advice - Answer -the information an insurer provides on the payment decision Medicare A - Answer -funded primarily by Medicare taxes paid by current workers to fund the costs of current beneficiaries. Patients are usually eligible for Medicare Part _ if they are a US citizen over age 65, disabled or have End Stage Renal Development and have paid Medicare wage taxes for at least forty (40) calendar quarters - known as categorical eligibility. Medicare Part _ covers inpatient hospital services, certain organ transplants, ESRD treatment, inpatient skilled nursing facility care, home health care and hospice care