Third party payer Study guides, Class notes & Summaries

NR 511 Midterm Exam Questions and Answers Latest Updated 2024 (GRADED) Which of the following demonstrates a subjective finding? Extremity edema. Eye color. rect! Pain level. Pulse rate. Pain is a subjective finding, as patients self-report their level of pain. All other options are objective findings. Question 2 0 / 1 pts The Affordable Care Act (ACA) which passed in 2010 has a number of provisions, including the establishment of health exchanges. The purpose of a health ins...

Which of the following Medicare policies determines if a particular item or service is covered by Medicare? - CORRECT ANSWER National Coverage Determination (NCD) A patient's employer has not submitted a premium payment. Which of the following claim statuses should the provider receive from the third-party payer? - CORRECT ANSWER Denied A billing and coding specialist should routinely analyze which of the following to determine the number of outstanding claims? - CORRECT ANSWER Agin...

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...

EDF 6557 Ethics Final Exam 2023 with 100% correct answers 1. Which of these is not one of the 10 sections of the BACB's Professional and Ethical Compliance Code for Behavior Analysts?: Ethical Responsibility to Supervisors 2. Code element 1.01 discusses reliance on scientific knowledge. Which of the following describes behavior adhering to this code element:: All of the above 3. On what sources should behavior analysts base their practices?: A and B 4. Amy spends extra time with her cli...

Customer service impressions are formed by the staff's ______ and _______ towards them. - ANSWER-attitude and behavior _______ may be any patient, family member, visitor, physician, other hospital, personnel, third party payer, vendors, suppliers, etc. - ANSWER-Customers Internal customers are people in other _______ , fellow ______, management, information services, etc. within the __________ who all work together in caring for the patient. - ANSWER-departments, employees, organization ...

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...

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...

NHA CBCS Exam Pep (New 2024/ 2025) | Questions and Verified Answers| 100% Correct| A Grade QUESTION What are three major kinds of government insurance plans? Answer: Medicare, Medicaid and children's health insurance program (SCHIP) QUESTION What is the difference between RA and EOB? Answer: RA=sent to the provider's office from the third-party payer. EOB=sent to the policyholder. QUESTION What is an allowable charge? Answer: The amount the he...

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 ...

Which of the following Medicare policies determines if a particular item or service is covered by Medicare? - Answer - National Coverage Determination (NCD) A patient's employer has not submitted a premium payment. Which of the following claim statuses should the provider receive from the third-party payer? - Answer - Denied A billing and coding specialist should routinely analyze which of the following to determine the number of outstanding claims? - Answer - Aging report Which of the...