Capitation Study guides, Class notes & Summaries

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...

IACCP MASTER QBANK QUESTIONS WITH VERIFIED SOLUTIONS GRADED A+ The SMC Capital, Inc. No-Action Letter (September 5, 1995) states that trade allocations may occur: A. Only on a rotational basis B. On a pro rata basis but other allocation methods can be used without violating the Advisers Act C. Only on a pro rata basis D. Based on the trader's good faith discretion - CORRECT ANS B. On a pro rata basis but other allocation methods can be used without violating the Advisers Act...

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...

capitation correct answers payment to health care providers on the basis of the number of people covered instead of payment for the services provided. care mgmt correct answers the process of developing and managing the care of a patient or resident, focusing on the quality of care delivered. care planning correct answers the process of developing a plan of care for a patient or resident. CARF international correct answers an organization that accredits rehabilitation and human services...

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 ...

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...

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 answerA. Names of medications Which of the following injectable drugs would be stored in refrigerator? A. Clindamycin B. Ciprofloxacin C. Cyanocobalamin D. Calcitonin-salmon - correct answerD. Calcitonin-salmon The requirement that a non-formulary medication be covered ...

Risk - answer-Risk is the uncertainty of loss Capitation - answer-Capitation payments are payments agreed upon in a capitated contract by a health insurance company and a medical provider. They are fixed, pre-arranged monthly payments received by a physician, clinic or hospital per patient enrolled in a health plan, or per capita. Under a health maintenance organization HMO service providers are paid a fixed monthly fee for each member. This concept is called - answer-Capitation When ca...

Management functions correct answers key functions of a manager including planning, organizing, staffing, directing & controlling Management connective processes correct answers mgmt functions that connect elements of the healthcare org. including communicating, coordinating and decision making Joint Commission correct answers primary accrediting organization for healthcare orgs. Healthcare Financial Mgmt Association (HFMA) correct answers Association of healthcare financial managers; c...

CSPR - Certified Specialist Payment Rep (HFMA) questions with correct answers 1. Steps used to control costs of managed care include :Answer: Bundled codes Capitation Payer and Provider to agree on reasonable payment 2. 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 3. Identify the various types of private health plan coverage:Answer: HMO Conven...