Capitation Study guides, Class notes & Summaries

Comlex Ethics Level 2 Exam 2024 (Verified Answers) 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...

CNML Test Exam Questions Revised With Correct Answers < Updated & Already Passed > DRGs - ANSWER : Diagnostic-Related Groups: payment rate based on specific diagnoses Prospective Payment System - ANSWER : Used by Medicare-participating hospitals: pretreatment diagnosis billings based on DRGs; rate decided ahead of time between insurance companies and hospitals Exclusive Provider - ANSWER : Used by HMO's: insurance coverage for contracted providers or institutions ...

Does the US have universal access to health insurance for its citizens? correct answer: No What are the subsystems of US health care delivery? correct answer: managed care military vulnerable populations integrated systems long term care public health seeks to achieve efficiency by integrating basic functions of healthcare delivery. Employs mechanisms to control utilization and costs of services, determines the price for services and what providers get paid, dominant system of U....

Risk Risk is the uncertainty of loss Capitation 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 Capitation When can a lapsed l...

MCOs manage - - Financing - Insurance - Delivery - Payment MCOs exercise formal control over the utilization of - Health Care Services The most common methods used for reimbursing providers are: - - Capitation - Discounted fees - Salaries Capitation - - The provider is paid a fixed monthly sum per enrollee - Often called a per member, per month (PMPM) payment Discounted Fees - - A modified form of fee-for-service - Discounts are offered in exchange for a certain volume of business Sa...

Risk correct answers Risk is the uncertainty of loss Capitation correct answers 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 correct answers ...

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...

Medical billing and coding latest version graded A+ Medical Insurance Financial plan (the payer) that covers the cost of hospital and medical care Policyholder Person who buys an insurance plan; the insured, subscriber, or guarantor Health Plan Individual or group plan that provides or pays for the cost of medical care Benefits What a health plan pays for services covered in an insurance policy; listed in the schedule of benefits. Medical Necessity Reasonable services of prov...

Legal Issues for COMLEX Level 1 Questions and Answers Already Passed A fellow physician is smelling of alcohol on the job. What do you do? Report him to state medical board and inform chief of staff, etc. A female is pregnant and she confides in the physician that the baby is NOT her husbands. The husband is also a patient of yours, but she request that you not tell her husband. What should the physician do? Do *NOT* tell the husband -Also, do NOT encourage the patient in any way -Le...

What is respondent superior or vicarious liability? - ️️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? - ️️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? - ️️it is when a patient voluntar...