CHFP Module 1 Certification Test Review 2026/2027

CHFP Module 1 Certification Test Review 2026/2027 Health care in the U.S. is not a simple relationship between a sick or injured person (referred to as the patient) and a party rendering medical care such as a physician or hospital (referred to as providers). There are a myriad of participants in the delivery of medical care, most of which are not directly involved with treating an illness or injury. These participants include insurers, regulators, and suppliers. is a pre-determined amount that the patient pays before the insurer begins to pay for services - -deductible a percentage of the insurance payment amount that is paid by the patient, along with the amount paid by the insurer. - -coinsurance a flat amount that the patient pays at each time of service - -copayment payment also includes amounts for services that are not included in the patient's benefit design and amounts for services balance billed by out-of-network providers. Payments typically does not include premium sharing by the patient. - -Out-of-pocket payment The amount payable out of pocket for healthcare services, which may includes deductibles, copayments, coinsurance, amounts payable by the patient for services that are not included in the patient's benefit design, and amounts "balance billed" by out-of-network providers. Health insurance premiums constitute a separate category of healthcare costs for patients, independent of healthcare utilization. - -Cost (to the patient) The expense (direct and indirect) incurred to deliver healthcare services to patients. - -Costs (to the provider) The amount payable to the provider (or reimbursable to the patient) for services rendered. - -Cost (to the health plan/insurer) The expense related to provided health benefits (premiums or claims paid) - -Cost (to the employer) The dollar amount a provider sets for services rendered before negotiating any discounts. The charge can be different from the amount paid. - -Charge The total amount a provider expects to be paid by health plans/payers and patients for healthcare services. - -Price An organization that negotiates or sets rates for provider services, collects revenue through premium payments or tax dollars, processes provider claims for service, and pays provider claims using collected premium or tax revenues. - CONTINUES...