health insurance pt 2.docx

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This document contains questions and answers about various health insurance programs and terms. It discusses eligibility for Medicare and Medicaid based on age and medical conditions. One question addresses that patients with end-stage renal disease qualify for Medicare regardless of age. Another question identifies Blue Cross and Blue Shield as the first prepaid health insurance plans in the US. The document also contains multiple-choice questions about billing Medicaid, the Balanced Budget Act, reimbursement systems, PPO networks, Physician-Hospital Organizations, and which part of Medicare would cover a hospitalization for pneumonia.

Education

health insurance pt 2
COMPLETE CORRECT ANSWERS FOR QUESTIONS 11-20 11. People who receive
Medicare A. are never eligible to receive Medicaid. B. may be eligible to receive
Medicaid if they meet the age requirement. C. may be eligible to receive Medicaid
coverage. D. can combine Medicare with TRICARE. 12. Ralph is assigning diagnosis and
procedure codes for a 35-year-old patient from New Mexico, who has hypertension and
end-stage renal disease. Would this patient qualify for Medicare? A. Yes, because the
patient has end-stage renal disease B. No, because the patient resides in New
Mexico C. No, because the patient is under age 65 D. Yes, because the patient has
hypertension 13. The first prepaid health insurance plans in the United States
were A. TRICARE and workers’ compensation. B. CHAMPUS and CHAMPVA. C. Blue
Cross and Blue Shield. D. Medicare and Medicaid. 14. Which of the following is the largest
privately underwritten health insurance contract in the world? A. Harless
program B. SCHIP C. Federal Employee Program (FEP) D. CHAMPVA program 15. A
provider is classified as a/an A. biller who submits claims to insurance
carriers. B. coder who provides medical record data. C. individual or group of individuals
that provide a health care service. D. beneficiary that provides information for insurance
coverage. 16. Tom is billing an emergency room visit for a Medicaid patient who’s being
seen for a wellness visit. Which one of the following statements is true as a result of the
Balanced Budget Act? A. There are new surgical treatments available. B. No new
applications are required for TAFT recipients. C. Patients have expanded preventive-care
benefits. D. There are new standards for TRICARE. 17. Dr. Singer is working within a
reimbursement system in which the insurance is billed after all the treatment has been
given to the patients. What is the main reason that the doctor orders more tests, exams, and
procedures under this system? A. Fear of being sued B. To increase resource
utilization C. To make a profit D. Because no one has to pay for it 18. With a PPO, the
beneficiary has the ability to A. choose a hospital within a 50-mile radius
only. B. choose a physician or hospital from the designated provider list. C. select a dentist
within a 10-mile radius. D. select an add-on policy for supplemental unemployment
benefits 19. Physician-hospital organizations (PHOs) are also called _______
organizations. A. medical staff-hospital B. health management C. individual
provider D. preferred provider 20. Mrs. Fang is a 72-year-old retired school teacher
who has been hospitalized for pneumonia. What type of insurance is most likely being used

to pay for her hospital stay? A. Medicare Part D B. Medicare Part B C. Medicare Part
A D. Medicare Part C

The document discusses group medical expense benefits and managed care plans. It provides 20 multiple choice questions about topics like extended care facility benefits, HMO models, second medical opinions, small employer coverage requirements, the origins of Blue Cross plans, and various managed care concepts. The questions cover basic definitions and requirements related to common medical insurance terms and plans.

Social security and medicare & medicaid spring 2014 abridged

Shepard Joy

This document provides an overview of Social Security, Medicare, Medicaid, and long-term care insurance as they relate to care of the older adult population. It discusses how Social Security provides retirement income and its sustainability issues. Medicare is described as providing hospital insurance and supplemental medical coverage for elders and some disabled. Medicaid is a joint federal-state program that covers medical costs for low-income individuals. Long-term care insurance can help cover long-term care costs for older adults.

Social security and medicare & medicaid fall 2013 abridged

Shepard Joy

Test Bank HCM 213 - 2023- 88 (1).pdf

AboAseel3

Short essay" Final " Chapter 7 • Categories Of Investment Decisions in Health Care: 1- Strategic Decisions 2- Expansion Decisions 3- Replacement Decisions The Objectives of The Capital Investment Decision المال رأس استثمار قرار أهداف 1- Financial Return 2- Future funding 3- Nonfinancial Benefits Strengths and weaknesses of Payback method Strengths: • Simple to calculate • Easy to understand • Weaknesses: • Answers in years not dollars • Disregards cash flows after payback • Does not account for the time value of money NPV (net present value) Internal Rate of Return Chapter 8 Financing Debt of Financing • Maturity: • Term Loans- paid off within 10 years • • Bonds- maturity in 20-35 years Type of Interest Loan • Fixed Interest rate debt • Variable rate demand bonds • Auction rate securities • Interest rate swap • Direct tax-exempt loan bond purchase by a bank Advantages: • Direct debt purchase is less time consuming and cheaper to issue • Loan does not require a credit rating by a rating agency • Loan avoids remarketing • If a loan qualifies as bank qualified, the bank can deduct 80% of its interest costs which results in lower interest Chapter 9 FIXED COSTS Costs that stay the same in total over the relevant range but change inversely on a per unit basis as activity changes. VARIABLE COSTS Costs that stay the same per unit but change directly in total with a change in activity over the relevant range: Total Variable Cost = Variable Cost per Unit x Number of Units of Activity. Break even formula can be used to: 1) Find Price 2) Find quantity 3) Find Fixed cost 4) Find Variable cost per unit There are four methods to apply economy of scale principles to affect health care: 1) Scale up volume. 2) Reduce costs. 3) Alter fixed and variable cost structure. 4) Innovate business model. direct costs: are those that an organization can measure or trace to a particular patient or service (e.g., the time a nurse or nursing assistant spends with a client) Indirect costs: are those that the organization is not able to associate with a particular patient or service (e.g., the cost of the billing clerk or computer system). Chapter 10 • What is the purpose of planning? To identify: • Goals • Objectives • Tasks • Activities • Resources needed • Name the key budgeting dimensions?  participation  Budget models  Budget detail  Budget forecast  Budget Modifications • What are the components of budgeting? Four major components: 1. Strategic Planning 2. Planning 3. Implementation 4. Controlling • Difference between static and flexible budget Static Budgets: forecast revenues and expenses for a single level of activity. Flexible Budgets: forecast revenues and expenses for various levels of activities. • Difference between participatory and authoritarian approach of budgeting. Authoritarian Approach Budgeting and decision making done by relatively few people concentrated in the highest level of the organizational structure, (opposite of the participatory approach The

testbankhcm213-2023-881-230619054201-9a053c3e.pdf

AboAseel3

Test Bank HCM 213 - 2023- 88 (1).pdf

AboAseel3

Test Bank HCM 213 - 2023- 88 (1).pdf

AboAseel3

• Categories Of Investment Decisions in Health Care: 1- Strategic Decisions 2- Expansion Decisions 3- Replacement Decisions The Objectives of The Capital Investment Decision أهداف قرار استثمار رأس المال 1- Financial Return 2- Future funding 3- Nonfinancial Benefits Strengths and weaknesses of Payback method Strengths: • Simple to calculate • Easy to understand • Weaknesses: • Answers in years not dollars • Disregards cash flows after pay • Categories Of Investment Decisions in Health Care: 1- Strategic Decisions 2- Expansion Decisions 3- Replacement Decisions The Objectives of The Capital Investment Decision أهداف قرار استثمار رأس المال 1- Financial Return 2- Future funding 3- Nonfinancial Benefits Strengths and weaknesses of Payback method Strengths: • Simple to calculate • Easy to understand • Weaknesses: • Answers in years not dollars • Disregards cash flows after pay • Categories Of Investment Decisions in Health Care: 1- Strategic Decisions 2- Expansion Decisions 3- Replacement Decisions The Objectives of The Capital Investment Decision أهداف قرار استثمار رأس المال 1- Financial Return 2- Future funding 3- Nonfinancial Benefits Strengths and weaknesses of Payback method Strengths: • Simple to calculate • Easy to understand • Weaknesses: • Answers in years not dollars • Disregards cash flows after pay • Categories Of Investment Decisions in Health Care: 1- Strategic Decisions 2- Expansion Decisions 3- Replacement Decisions The Objectives of The Capital Investment Decision أهداف قرار استثمار رأس المال 1- Financial Return 2- Future funding 3- Nonfinancial Benefits Strengths and weaknesses of Payback method Strengths: • Simple to calculate • Easy to understand • Weaknesses: • Answers in years not dollars • Disregards cash flows after pay • Categories Of Investment Decisions in Health Care: 1- Strategic Decisions 2- Expansion Decisions 3- Replacement Decisions The Objectives of The Capital Investment Decision أهداف قرار استثمار رأس المال 1- Financial Return 2- Future funding 3- Nonfinancial Benefits Strengths and weaknesses of Payback method Strengths: • Simple to calculate • Easy to understand • Weaknesses: • Answers in years not dollars • Disregards cash flows after pay • Categories Of Investment Decisions in Health Care: 1- Strategic Decisions 2- Expansion Decisions 3- Replacement Decisions The Objectives of The Capital Investment Decision أهداف قرار استثمار رأس المال 1- Financial Return 2- Future funding 3- Nonfinancial Benefits Strengths and weaknesses of Payback method Strengths: • Simple to calculate • Easy to understand • Weaknesses: • Answers in years not dollars • Disregards cash flows after pay • Categories Of Investment Decisions in Health Care: 1- Strategic Decisions 2- Expansion Decisions 3- Replacement Decisions The Objectives of The Capital Investment Decision أهداف قرار استثمار رأس المال 1- Financial Return 2- Future funding 3- Nonfinancial Benefits Strengths and weaknesses of Payback method Strengths: • Simple to calculate • Easy

Mezo2030.pdf

fahad429887

Lowering Costs o Patient Protection and Affordable Care Act (ACA) o CMS trying to control rising costs o Value Based Purchasing (VBP) • Goals of the Health Care System o Access o Cost o Quality • Changing Methods Of Health Care Financing and Delivery o Requirement that almost all individuals have insurance coverage. o Requirement that states create insurance exchanges. o Provisions for expansion of Medicaid (is a social health care program for families and individuals with low income and resources). o Provisions for medical loss ratio and premium rate reviews. o Bundled payments and VBP. o Accountable Care Organizations. • List any four factors contributing to decrease the cost of healthcare? o Value-based purchasing (VBP) o Management of physician preferences in medical devices o Generic drugs coming onto the market o Lean/six sigma initiatives 5-Informed consumers responsible for more of the cost of care o Workplace wellness and employer programs o More robust use of health IT to manage populations and prevent medical errors • Factors Contributing to Increases in Costs of Care? o Emerging medical technology. o chronic diseases. o Aging population. o professional liability and malpractice costs. o Influx of participants into the market due to extended coverage and insurance mandate ❖ Easy question: • Statements used in Not-for-Profit Health Care Entities OR list the financial Statements used in Not-for-Profit Health Care Entities o Balance sheet o Statement of Operations o Statement of Changes in Net Assets o Statement of Cash Flows • Current assets may include : o cash, investments, limited or restricted as to use current position, patient accounts receivable, estimated receivables from 3 • Non-current assets may include: o self insurance, benefit plans, capital equipment (includes long-lasting goods acquired and owned by a company or organization that are not consumed in the normal course of business—goods such as machinery, trucks, large computers, and office furniture), held by the board under bond indenture agreements, property and equipment, goodwill, net of accumulated amortization. • Current Liabilities could include: o accounts payable, accrued expenses (expenses are recognized when incurred), salaries & wages, estimated payables to third parties, short term borrowings, commercial paper • Noncurrent Liabilities could include: o long term debt, self-insurance reserves, accrued pension and retiree health costs • Operating Activities o Inflows : Receipts from customers • Cash dividends received • Interest from borrowers • Other o Outflows :Salaries and wages • Payments to suppliers • Taxes and fines • Interest paid to lenders • Other • Investing Activities o Inflows: • Selling long-term productive assets • Selling equity investments • Collecting principal on loans • Other o Outflows :• Purchasing long-term productive assets • Purchasing equity investments • Purchasing debt investments • Other • Financing Activities o Inflows: • Issuing

The document provides an overview of different types of health insurance in the United States. It discusses that Medicare is a federal program for aged and disabled individuals that covers hospital and physician costs. Medicaid is also a federal program administered by state governments that provides health insurance for indigent persons. Commercial health insurance can be purchased directly or through employers and usually requires monthly premiums and various out-of-pocket costs. Managed care plans make up the largest type of commercial health insurance and typically designate a primary care physician.

Medicare, Medicaid, and the Health Insurance Portability and Accou.docx

buffydtesurina

Medicare, Medicaid, and HIPAA have impacted the healthcare industry both positively and negatively. Some key benefits include Medicare providing affordable coverage to seniors and people with disabilities, Medicaid expanding coverage to low-income groups, and HIPAA strengthening privacy protections for patient information. However, challenges also exist such as high administrative costs for the programs, low reimbursement rates discouraging some providers from accepting Medicaid, and HIPAA compliance adding expenses for healthcare organizations. On balance, the policies aim to expand access to care while balancing costs and privacy considerations across the complex U.S. healthcare system.

Liberty university busi 311 quiz 5 complete solutions correct answers slideshare

Song Love

This document contains 30 multiple choice questions from a Liberty University BUSI 311 quiz on healthcare finance topics. The questions cover a range of issues including types of health plans, Medicaid/Medicare policies and eligibility, the Affordable Care Act, cost control efforts, and more. Sample questions addressed managed care options, provisions of the Medicare Prescription Drug Act, factors that increase Medicaid spending, and coverage exclusions under Medicare.

Test Bank PHC216 - 2023-88 (1).pdf

MansourSumaily

Medical Ethics Today The BMA's Handbook of Ethics and Law Third Edition British Medical Ethics Department Chapter 2 Consent, Choice and Refusal: Adults with Capacity Chapter 3 Treating Adults who Lack Capacity Medical Ethics  ‘Medical Ethics’ is one subset of the broader disciplines of ‘healthcare ethics’ and ‘bioethics’. It overlaps with both but focuses on the duties of doctors.  Nowadays, ‘ethics’ can either mean conforming recognized standards of practice or describe the general study of morality.  Doctors have a duty to provide ‘benefit’ to the sick, respect confidentiality and demonstrate integrity. Such values, often labelled ‘Hippocratic’. Key Concepts in Medical Ethics Many of the most commonly used ethical terms are self-evident, others may require some interpretation  Self-determination or autonomy  Honesty or integrity  Confidentiality  Fairness and equity  Harm and benefit The Nature and Purpose of Consent Legal Consent is trigger that allows treatment. Some interventions can be harmful (side effects, etc). Some interventions could be considered assault or battery. Ethical Patients’ views should be respected. Health Care is a partnership between doctor and patient. Adult patients with capacity have the right to choose what happens to their bodies. The patient's consent is then the trigger that allows treatment or examination to take place. Seeking consent from patients, therefore, forms a crucial pan of the practice of almost every doctor. It is central to the partnership between doctor and patient. Patients should be listened to and their views respected in the course of discussion Consent is central to good medical practice. Consent should be perceived as a continuing process rather than a one-off decision. Consent is a legal requirement. Seeking consent is also a moral requirement and the British Medical Association (BMA) believes that respect for others and their rights lies at the heart of this issue. Society values individuals and their dignity. Many medical and surgical interventions could be harmful but are acceptable because the expected benefits outweigh the harms. Patients agree to the invasive procedures of medicine, which, under any other circumstances, could lead to criminal charges. Doctors must be aware that if they fail to seek consent from patients who have the capacity they could be vulnerable to criminal prosecution for battery or assault, or a challenge in civil law for negligence or breach of the patient's human rights. Adult patients with capacity have both an ethical and a legal right to self-determination and to respect for their autonomy. • patient gives consent when he has capacity, is adequately informed and voluntarily agrees to treatment. • Before examining or treating adult patients with capacity, doctors must obtain patient consent, except in emergencies for example where compulsory treatment is authorized by mental health legislation. • Adults are always presumed to have capacity unless demo

Liberty university busi 311 quiz 7 complete solutions correct answers slideshare

Song Love

ANSWER ALL THE QUESTIONS SURE THEY ARE ALL CORRECTSEND BACK.docx

write22

A health insurance roadmap

Tony Steuer, CLU, LA, CPFFE

A health insurance roadmap takes a look at some simple solutions to the complex issues facing health insurance, medicare, medicaid, long term care insurance, and the high cost of health expenses in retirement. This will work because so much of this is already in place and a lot of the rest would be quick and easy to implement. As in all areas, knowledge is power. Consumers can take control of your insurance portfolio by becoming educated about insurance. Better education and understanding will lead to positive results for consumers and for the insurance industry.

Which one of the following statements accurately represents the practice.docx

write5

US Goverment Accountability Office Telehealth report

VSee

This document summarizes a Government Accountability Office report on telehealth and remote patient monitoring use in Medicare and selected federal programs. It finds that while telehealth and remote patient monitoring have potential to improve care, low utilization exists in Medicare due to coverage and payment barriers. Emerging payment models may expand use by addressing restrictions. The report also describes oversight of Medicare telehealth payments and factors affecting use cited by provider, patient, and payer associations.

Liberty university busi 311 quiz 8 complete solutions correct answers slideshare

Song Love

1. Practitioners that have specialized training in the muscul.docx

honey690131

1. Practitioners that have specialized training in the musculoskeletal system are called A. occupational therapists. B. physical therapists. C. rehabilitation specialists. D. chiropractors. 2. The Health Care and Education Reconciliation Act of 2010 was mandated under the A. Office of the Inspector General. B. American Health Information Management Association (AHIMA). C. Medicare Act of 1965. D. Affordable Care Act (ACA). 7. Heat, water, sound, and ultrasound procedures are often administered by A. dental assistants. B. nurses aides. C. medical assistants. D. physical therapy aides. 8. What term is used to refer to the process of communicating with people from different health care backgrounds? A. Professional coarctation B. Interprofessional or interdisciplinary collaboration C. Health care interdisciplinary communication D. Peer-to-peer review 10. Which one of the following statements indicates that an individual understands how health insurance coverage works? A. "Because of the Affordable Care Act (ACA), I don't need to apply for health care insurance." B. "Because I work in a hospital, I'm eligible for Medicaid coverage." C. "Because I'm 60 years old, I can get Medicare coverage." D. "Because my father served in the military, I'm eligible for TRICARE insurance." 12. Identifying key beliefs and cultures is a/an A. professional characteristic of a health care worker. B. element of becoming culturally sensitive. C. component of nursing treatment in the ICU. D. necessary for the administration of religious rites. 18. What is the purpose of the Health Insurance Portability and Accountability Act (HIPAA)? A. To determine the scope of practice for health care workers B. To protect doctors against malpractice suits C. To protect and enhance the privacy of the patient D. To ensure health care workers' safety on the job 19. Which one of the following statements about the responsibilities of medical billers and coders is correct? A. They use three code sets: ICD, CPT, and HCPCS. B. They play a minor role in health care reimbursement. C. They create documentation required for reimbursement from only third-party payers. D. They should not examine patient records. 20. Which one of the following health care workers would be employed to provide services at a rehabilitation center ? A. Louisa, a medical coder B. Maria, a speech pathology assistant C. Patrick, a pharmacy technician D. Jim, a health information manager ...

Question 1 (1 point)What factor is medical necessity based on.docx

makdul

Question 1 (1 point) What factor is medical necessity based on? Question 1 options: A) The beneficial effects of a service for the patient’s physical needs and quality of life B) The cost of a service compared with the beneficial effects on the patient’s health C) The availability of a service at the facility D) The reimbursement available for a given service Save Question 2 (1 point) The first prospective payment system (PPS) for inpatient care was developed in 1983. The newest PPS is used to manage the costs for Question 2 options: A) medical homes. B) assisted living facilities. C) home health care D) inpatient psychiatric facilities Save Question 3 (1 point) The category “Commercial payers” includes private health information and Question 3 options: A) employer-based group health insurers. B) Medicare/Medicaid. C) TriCare D) Blue Cross and Blue Shield Save Question 4 (1 point) LCDs and NCDs are review policies that describe the circumstances of coverage for various types of medical treatment. They advise physicians which services Medicare considers reasonable and necessary and may indicate the need for an advance beneficiary notice. They are developed by the Centers for Medicare and Medicaid Services (CMS) and Medicare Administrative Contractors. LCD and NCD are acronyms that stand for Question 4 options: A) local contractor's decisions and national contractor's decisions. B) list of covered decisions and noncovered decisions. C) local covered determinations and noncovered determinations. D) local coverage determinations and national coverage determinations. Save Question 5 (1 point) A Medicare patient was seen by Dr. Zachary, who is a nonparticipating physician. The charge for the office visit was $125. The Medicare beneficiary had already met his deductible. The Medicare Fee Schedule amount is $100. Dr. Zachary does not accept assignment. The office manager will apply a practice termed as "balance billing," which means that the patient is Question 5 options: A) financially liable for charges in excess of the Medicare Fee Schedule, up to a limit. B) financially liable for the Medicare Fee Schedule amount. C) financially liable for only the deductible. D) not financially liable for any amount. Save Question 6 (1 point) CMS adjusts the Medicare Severity DRGs and the reimbursement rates every Question 6 options: A) quarter B) calendar year beginning January 1 C) month D) fiscal year beginning October 1 Save Question 7 (1 point) The prospective payment system used to reimburse hospitals for Medicare hospital outpatients is called Question 7 options: A) MS-DRGs B) APGs C) RBRVS D) APCs. Save Question 8 (1 point) An Advance Beneficiary Notice (ABN) is a document signed by the Question 8 options: A) physician advisor indicating that the patient's stay is denied. . B) ...

Hvc resident-session-2

DUSENGUMUREMYIJeande

This document discusses health care costs, payment models, and insurance in the United States. It explains that health insurance status and type of coverage significantly impact out-of-pocket costs and ability to adhere to treatment recommendations. Various insurance types like private, employer, government, and uninsured are compared. Reimbursement models for providers like fee-for-service, diagnosis-related groups, and accountable care organizations are also overviewed. The document advocates for individualizing care based on insurance coverage to improve quality while decreasing unnecessary costs.

Test Bank For Timby's Introductory Medical-Surgical Nursing, 13th Edition by ...

nursing premium

Patient Resource: Medicare Observation Versus Admit Days

Terri Embry RN BS

GRiMagells

Melissa Allen, MSCH

A Medicare Part D grievance is a complaint about the way a Medicare prescription drug plan is providing care. Anyone enrolled in a Part D plan can file a grievance if they are unhappy with the customer service or behavior of the plan's staff. Grievances must be filed within 60 days and will generally be resolved within 30 days. Common reasons for filing a grievance include problems with copays, pharmacy access issues, or rude treatment from staff. The enrollee or their representative can file a grievance directly with the Part D plan.

Fall 2012: Arkfeld Notes

Indiana State Chiros

The document discusses documentation problems found in a 2009 Office of Inspector General report regarding chiropractic claims submitted to Medicare. Some key findings included that 83% of chiropractic claims failed to meet one or more Medicare documentation requirements, treatment plans were often missing important elements like goals and measures, and efforts to stop payments for maintenance therapy have been ineffective. The document urges chiropractors to use the report to improve policies and documentation skills in order to become compliant with Medicare standards.

Kozier and Erbs Fundamentals of Nursing 8th Edition Berman Test Bank

SeptemberParsons

Post-Acute Care & Beyond

Chris Hoffmann

21985527-Community-Health-Nursing-Exam.pdf

donnutt buy

This document contains a community health nursing exam with 61 multiple choice questions covering various topics in community health and public health nursing such as the goals and principles of community health nursing, the roles and functions of public health nurses, epidemiology, primary health care, and traditional and alternative health care. The questions assess understanding of key concepts, laws, processes, and roles in community and public health nursing practice.

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