Out of pocket payment Study guides, Class notes & Summaries

AHIP 2023 Final QUESTIONS AND ANSWERS Mr. Lopez, who is fairly well-off financially, would like to enroll in a Medicare prescription drug plan you represent and simply give you a check to cover his premiums for the entire year. What should you tell him? - ANSWERE He will need to mail in his payment with his enrollment form. Mrs. Chou likes a Private Fee-for-Service (PFFS) plan available in her area that does not include drug coverage. She wants to enroll in the plan and enroll in a s...

Accumulated Depreciation - ANSWER-The total decrease in an item's value over a period of time. Formula: (Annual Depreciation x Number of years used) Actual Cash Value (ACV) - ANSWER-A valuation method used by insurers to reflect an item's current market value right before being damaged or destroyed. Formula: (Replacement cost - Accumulated Depreciation) Adhesion - ANSWER-One of the characteristics of an insurance contract. Means that one party (the insurer) sets the terms, and the other ...

Under a traditional IRA, interest is taxed: Only if withdrawn prior to age 59 1/2 According to the capital gains rate Upon distribution During the accumulation phase - ANSWER-Upon distribution Which of these statements concerning Traditional IRAs is CORRECT? Earnings are not taxable when withdrawn Earnings are taxable when withdrawn Contribution are never tax deductible Contributions are always made by the employer - ANSWER-Earnings are taxable when withdrawn Wh...

1. Which statement accurately describes the primary purpose of the state nurse practice act (NPA)? a. To test and license LPN/LVNs. b. To define the scope of LPN/LVN practice. c. To improve the quality of care provided by the LPN/LVN. d. To limit the LPN/LVN employment placement. ANS: B While improving quality of care provided by the LPN/LVN may be a result of the NPA, the primary purpose of the NPA of each state defines the scope of nursing practice in that state. PTS: 1 DIF:...

Chapter 01: Caring for Medical-Surgical Patients deWit: Medical-Surgical Nursing: Concepts & Practice, 4th Edition MULTIPLE CHOICE 1. Which statement accurately describes the primary purpose of the state nurse practice act (NPA)? a. To test and license LPN/LVNs. b. To define the scope of LPN/LVN practice. c. To improve the quality of care provided by the LPN/LVN. d. To limit the LPN/LVN employment placement. ANS: B While improving quality of care provided by the LPN/LVN may be a result...

According to the RAND Health Insurance Experiment, which variable has the greatest power in explaining health expenditures? A.) Welfare eligibility B.) Prior utilization C.) Physical health (based on self-reported measures) D.) General health (based on self-reported measures) E.) Mental health (based on self-reported measures) - correct answer B.) Prior utilization A provision in some group life insurance plans that provides for the payment of all or part of the death benefit...

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...

Steps used to control costs of managed care include: correct answer: Bundled codes Capitation Payer and Provider to agree on reasonable payment DRG is used to classify correct 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 correct answer: HMO Conventional PPO and POS HDHP/SO plans - high-deductible hea...

CRCR EXAM WITH CORRECT CHOICES, CERTIFIED AND VERRIFIED 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 patie...

According to the RAND Health Insurance Experiment, which variable has the greatest power in explaining health expenditures? A.) Welfare eligibility B.) Prior utilization C.) Physical health (based on self-reported measures) D.) General health (based on self-reported measures) E.) Mental health (based on self-reported measures) - Answer- B.) Prior utilization A provision in some group life insurance plans that provides for the payment of all or part of the death benefit in the e...