Medicare payment Study guides, Class notes & Summaries

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 s...

MHA 706 Midterm- Lord 2024 Exam with Complete Solutions Rated A+ Proprietorships & Partnerships: Pros & Cons - Correct Answer Pros: Ease of Information, Subject to a few regulations, no corporation income taxes. Cons: Limited life, difficult to transfer, unlimited life, difficult to raise capital. Corporations: Pros & Cons - Correct Answer Pros: Unlimited life, easy transfer of ownership, limited liability, ease of raising capital. Cons: Cost of formation and reporting, double or triple ta...

HFMA CRCR EXAM LATEST 2023-2024 EXAM 170+ QUESTIONS AND CORRECT ANSWERS(VERIFIED ANSWERS) IF outpatient diagnostic services are provided within three days of the admission of a Medicare beneficiary to an IPPS (Inpatient Prospective Payment System) hospital, what must happen to these charges - ANSWER- They must be billed separately to the part B Carrier what is a recurring or series registration? - ANSWER- One registration record is created for multiple days of service What are nonemergen...

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...

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...

NJ Health and Accident Questions and Answers 100% Pass In what form do disability income policies typically pay benefits Periodic income The Mandatory health policy provision states that the policy, including endorsements and attached papers, constitutes The entire insurance contract between the parties The entire contract includes the actual policy and the application employer sponsored group health insurance provides coverage for which of the following Alcoholism The term w...

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...

Does Medicare pay for all tests ordered by Providers? - No, they need to determine if it's covered and medically necessary. For larger physician practices, how often does the OIG suggest reporting compliance activities to the board of directors? - Regularly According to the OIG, medically unnecessary services can be billed to Medicare for what purpose? - To receive a denial so a claim can be submitted to a secondary payer. Which component of the OIG has a duty of operating the OIG hotline...

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

Which of the following statements are true of HFMA's Financial Communications Best Practices - The best practices were developed specifically to help patients understand the cost of services, their individual insurance benefits, and their responsibility for balances after insurance, if any. The patient experience includes all of the following except: - The average number of positive mentions received by the health system or practice and the public comments refuting unfriendly posts on soci...