Capitation Study guides, Class notes & Summaries

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...

TEST BANK FOR MEDICAL SURGICAL NURSING CONCEPTS AND PRACTICE 3TH EDITION DEWIT-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 improving quality of care provided by the LPN/LVN may be a result of the NPA, the primary purpose of the NPA of each state defi...

Knowing which of the following can best assist a technician in the prevention of data entry errors? A. Names of medications B. Insurance co-payments C. Pharmacokinetics D. Physician contact information (Ans- A. Names of medications Which of the following injectable drugs would be stored in refrigerator? A. Clindamycin B. Ciprofloxacin C. Cyanocobalamin D. Calcitonin-salmon (Ans- D. Calcitonin-salmon The requirement that a non-formulary medication be covered only if approved...

Capitation A covers all services an enrollee may need during an entire year Market Justice most equitably distributed through the market forces of supply and demand, rather than government interventions. Distributed on the basis of willingness and ability to pay Social Justice An ideal that embraces all aspects of civilized life and that is linked to fundamental notions of fairness and to cultural beliefs about right and wrong. defensive medicine Ordering more tests and procedures than...

1-day payment window rule - Answer a Medicare requirement similar to the day payment window rule that applies to inpatient poychiatric hosp tals, inpatient rehabilitation facilities, long term care facilities, and chil dren's and cancer hospital. 3-day payment window rule - Answer a Medicare requirement that all diagnostic and clinically related non-diagnostic outpatient services provided with in three days of an inpatient admission must combined the inpa- tient claim when they are provided ...

Complete Solutions Manual for Government and Not-for-Profit Accounting: Concepts and Practices, 9th Edition 9e by Michael H. Granof, Saleha B. Khumawala, Thad D. Calabrese. ISBN-13: 3898 1 The Government and Not- for- Profit Environment 1 How Do Governments and Not- For- Profits Compare With Businesses? 2 In Practice: Why Is State And Local Government Accounting Important? 6 What Other Characteristics of Governments and Not- For- Profits Have Accounting Implications? 9 How Do Gove...

Exam 3: PNR207 / PNR 207 (Latest Update 2024 / 2025) Transition to PN Practice - Capstone | Review Guide Questions and Verified Answers | 100% Correct | Grade A - Fortis Question: Reimbursement based on negotiated costs Answer: Retrospective payment system Question: System in which federal government announces to a hospital in advance what it will pay for each client based on the clients DRG category, regardless of the length of stay Answer: Prospective payment system ...

_____ is the recording of all treatments, diagnoses, and other medical services. It is commonly done electronically but may be done on paper. - ️️charge capture ____ is the process of translating treatments, diagnoses, and other medical services into established alphanumeric codes so that they can be submitted as part of a claim. - ️️coding When a healthcare organization such as a physician group receives a per-head fee for each individual enrolled in a plan, it is known _____. A c...

What is respondeat superior or vicarious liability? - ANSWER ☑☑it is when an employer is responsible for the actions of their employees. Both terms essentially mean the same thing. what is res ipsa loquitur? - ANSWER ☑☑it is when a physician acts negligently to lead to an accident. the thing speaks for itself Example is if a physician prescribes the wrong medication leading to injury or leaves a scalpel inside someone . What is contributory negligence? - ANSWER ☑☑it is...

PTCB EXAM 2024 WITH 100% ACCURATE SOLUTIONS Knowing which of the following can best assist a technician in the prevention of data entry errors? A. Names of medications B. Insurance co-payments C. Pharmacokinetics D. Physician contact information - correct answer A. Names of medications Which of the following injectable drugs would be stored in refrigerator? A. Clindamycin B. Ciprofloxacin C. Cyanocobalamin D. Calcitonin-salmon - correct answer D. Calcitonin-salmon The requ...