Third party payer Guides d'étude, Notes de cours & Résumés

CSPR - Certified Specialist Payment Rep (HFMA) Questions and Answers 2023 Steps used to control costs of managed care include: Bundled codes Capitation Payer and Provider to agree on reasonable payment DRG is used to classify 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 Identify the various types of private health plan coverage HMO Conventional PPO and POS H...

MHA 610 Final Exam Questions & Answers 2023/2024 "What is meant by the term "health care costs" Give the 3 meanings - ANSWER-1. Billings and premiums that the patient pays 2.How much debt the nation is in for medical expenses 3. The cost of producing services such as supplies and equipment Rand Health - How does it show relationship of rising costs and third party reimbursement? - ANSWER-The experiment showed how people who paid out of pocket were less likely to utilize the services, m...

Through what document does a hospital establish compliance standards? code of conduct What is the purpose OIG work plant? Identify Acceptable compliance programs in various provider setting If a Medicare patient is admitted on Friday, what services fall within the three-day DRG window rule? Non-diagnostic service provided on Tuesday through Friday What does a modifier allow a provider to do? Report a specific circumstance that affected a procedure or service without chan...

Master Study Guide I Pre-Encounter Customer Service impressions are formed by the staff's ATTITUDE (state of mind) and BEHAVIOR (action/reaction) towards them. correct answer: 1.ATTITUDE / BEHAVIOR _____________ may be any patient, family member, visitor, physician, other hospital personnel, third party payer, vendors, suppliers, etc. correct answer: 2.CUSTOMERS Internal customers are people in other____________, fellow ___________, management, information services, etc. within th...

Olds Maternal-Newborn Nursing & Women’s Health Across the Lifespan 11th Edition Test Bank Instant delivery Old’s Maternal-Newborn Nursing and Women’s Health, 11e (Davidson/London/Ladewig) Chapter 1 Contemporary Maternal-Newborn Nursing 1) The nurse is speaking to students about changes in maternal-newborn care. One change is that self-care has gained wide acceptance with clients and the healthcare community due to research findings that suggest that it has which effect? A) Shortens newborn...

Olds Maternal-Newborn Nursing & Women’s Health Across the Lifespan 11th Edition Test Bank Instant delivery Old’s Maternal-Newborn Nursing and Women’s Health, 11e (Davidson/London/Ladewig) Chapter 1 Contemporary Maternal-Newborn Nursing 1) The nurse is speaking to students about changes in maternal-newborn care. One change is that self-care has gained wide acceptance with clients and the healthcare community due to research findings that suggest that it has which effect? A) Shortens newborn...

Olds Maternal-Newborn Nursing & Women’s Health Across the Lifespan 11th Edition Test Bank Instant delivery Old’s Maternal-Newborn Nursing and Women’s Health, 11e (Davidson/London/Ladewig) Chapter 1 Contemporary Maternal-Newborn Nursing 1) The nurse is speaking to students about changes in maternal-newborn care. One change is that self-care has gained wide acceptance with clients and the healthcare community due to research findings that suggest that it has which effect? A) Shortens newborn...

Steps used to control costs of managed care include: - ANSWER-Bundled codes Capitation Payer and Provider to agree on reasonable payment 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 Identify the various types of private health plan coverage - ANSWER-HMO Conventional PPO and POS HDHP/SO plans - high-deductible health plans with a savings...

how does the registration process begin in an outpatient setting? - ANS - when a new patient calls the office for an appointment to see a provider. what does a front staff member do once they obtain information from a new patient? - ANS - they create an account that includes the patient's identity, medical condition, and insurance/payment info. what does a front staff member do once they obtain information from an established patient? - ANS - the staff member searches for the patient reco...

CRCR Exam Prep What are collection agency fees based on? - correct answer A percentage of dollars collected Self-funded benefit plans may choose to coordinate benefits using the gender rule or what other rule? - correct answer Birthday In what type of payment methodology is a lump sum or bundled payment negotiated between the payer and some or all providers? - correct answer Case rates What customer service improvements might improve the patient accounts department? - correct answer Ho...