Homework Answers
36. Option C is correct An organization that process claims and provide administrative services for nother organization is known as TPA (third-party administrator)
37. Option D is correct as the affordable care act includes all these services like emergency services, prescription drugs and laboratory services
38. Option C is correct as the services that are needed to improve the patient's current health are considered medically necessary.
39. Option B is correct i.e. preventive services as prophylatic action
40. Option A is correct as Medicare Part A of the medicare cover inpatient hospital charges
41. Option A is correct as the allowed amount for medicare charges is determined using fee schedule
42. All are correct as RBRVS is consist of three parts provider or physician work, chrged base overhead and professional liability expenses
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36. An organization that processes daims and provides administrative services for 1s a. utilization management. b....
AH Sfganization that processes claims and provides administrative services for another organization is utilization management. b....
AH Sfganization that processes claims and provides administrative services for another organization is utilization management. b. resource-based relative value system. third-party administrator. d. provider network. a. C. 37. The Affordable Care Act includes which of the following categories of essential health benefins a. Emergency services b. Laboratory services c. Prescription drugs d. All of the above 38. Services that are needed to improve the patient's current health are considered a. elective. b. preventive. c. medically necessary. d. provider network. 39....
TUU UI WC dove An organization that processes claims and provides administrative services for another organization...
TUU UI WC dove An organization that processes claims and provides administrative services for another organization a. utilization management. b. resource-based relative value system. c. third-party administrator. d. provider network. The Affordable Care Act includes which of the following categories of essential health benefits! a. Emergency services b. Laboratory services c. Prescription drugs d. All of the above 38 Services that are needed to improve the patient's current health are considered a. elective. b. preventive. c. medically necessary. d. provider...
QUESTION 17 Match to term to the correct definition A. publication where GAAP is presented for...
QUESTION 17 Match to term to the correct definition A. publication where GAAP is presented for the health care industry applies to investor-owned, for-profit organizations, created expanded duty for B. the governing board in the performance of its fiduciary duties (financial reporting) ca uniform method used by CMS for health care providers and medical suppliers to code for professional services, procedures and supplies - Audit and Accounting Guide for Health Care Organizations (AAG-HCO) Sarbanes-Oxley Act (SOX) Healthcare Common Procedure Coding...
Examples of Health Care Fraud include: A. All of the above. B. Billing for services not...
Examples of Health Care Fraud include: A. All of the above. B. Billing for services not rendered. C. Billing for services not medically indicated or necessary D. Physician billing for services provided by interns and residents. E. Giving health care providers inducements in exchange for referrals. C Lawsuits filed by private individuals under the False Claims Act are referred to as actions. C A. All of the above. B. Whistleblower C C. Relator C D. Qui Tam The Medicare Program:...
69) A policy that pays you back for actual expenses is called A) An indemnity plan....
69) A policy that pays you back for actual expenses is called A) An indemnity plan. B) A deductible plan. C) A reasonable and customary plan. D) A reimbursement plan. E) A coinsurance plan m The set amount that you must pay toward medical expenses before the insurance company pays benefits is called A) Deductible. B) Reimbursement C) Indemnity. D) Internal limit. E) Reasonable and customary charges. 71) Which of the following is a government health care program? A) Health...
QUESTIONS 1. Which case-management strategy was used in this case study? Describe how. A. Utilization management...
QUESTIONS 1. Which case-management strategy was used in this case study? Describe how. A. Utilization management B. Critical pathways C. Disease management D. Demand management Chapter 22: Case Management Student Case Studies Through a nurse's case-management activities, general community deficiencies in quality and quantity of health services are often discovered. When lack of care or services is observed at individual and family intervention levels, the nurse can, through case management, intervene at the community level to make changes. George S....
23. NAMI (National alliance for the mentally II) is a d professional organization for the mental...
23. NAMI (National alliance for the mentally II) is a d professional organization for the mental health professionals b. advocacy group for the mentally ill factor that contributed siknificantly to deinstitutionalization of mentallyill atients was: a. The development of effective pharmacologic treatments b. Rising concern over the costs of inpatient care c. The Quaker movement for "moral treatment" 24. One reason why only a small percentage of those in need of mental health services actually receives them is: Mental health...
Identification and explanation of the main cost management problem using the cost management theory, a. Identification...
Identification and explanation of the main cost management
problem using the cost management theory,
a. Identification of (5) external or internal causes
that originates the proposed main cost management problem,
b. What should be Bay Area Health Network’s mission in
the context of the proposed main cost management problem and
internal and external causes?
c. Propose an adequate ABC analysis for Bay Area Health
Network’s situation to answer the questions presented in the
case
d. Define (5) cost management strategies...
1. What organization called for the establishment of “rules of the road” for distributing health care...
1. What organization called for the establishment of “rules of the road” for distributing health care data? a. Office of the National Coordinator for Health Information Technology (ONC) b. Department of Defense (DOD) c. Health and Human Services (HHS) d. Institute of Medicine (IOM) 2. Computerized Provider Order Entry Systems (CPOE) are intended to achieve the following specific objectives. Select four that apply. a. Reduce the risk of illegibility b. Eliminate the use of paper documents c. Eliminate medical error...
14. An advantage to a database is that it _____. a. Reduces redundancy b. Controls the data stored in it d. Establishes...
14. An advantage to a database is that it _____. a. Reduces redundancy b. Controls the data stored in it d. Establishes data sets 15. A primary key in a table: a. Must be unique for each row in the table b. Must be numeric c. Should not be used to join tables together d. Is a constant data element across all rows 16. Which of the following variables is nominal? a. Patient gender b. Length of stay c. Severity...
AH Sfganization that processes claims and provides administrative services for another organization is utilization management. b. resource-based relative value system. third-party administrator. d. provider network. a. C. 37. The Affordable Care Act includes which of the following categories of essential health benefins a. Emergency services b. Laboratory services c. Prescription drugs d. All of the above 38. Services that are needed to improve the patient's current health are considered a. elective. b. preventive. c. medically necessary. d. provider network. 39....
TUU UI WC dove An organization that processes claims and provides administrative services for another organization a. utilization management. b. resource-based relative value system. c. third-party administrator. d. provider network. The Affordable Care Act includes which of the following categories of essential health benefits! a. Emergency services b. Laboratory services c. Prescription drugs d. All of the above 38 Services that are needed to improve the patient's current health are considered a. elective. b. preventive. c. medically necessary. d. provider...
QUESTION 17 Match to term to the correct definition A. publication where GAAP is presented for the health care industry applies to investor-owned, for-profit organizations, created expanded duty for B. the governing board in the performance of its fiduciary duties (financial reporting) ca uniform method used by CMS for health care providers and medical suppliers to code for professional services, procedures and supplies - Audit and Accounting Guide for Health Care Organizations (AAG-HCO) Sarbanes-Oxley Act (SOX) Healthcare Common Procedure Coding...
Examples of Health Care Fraud include: A. All of the above. B. Billing for services not rendered. C. Billing for services not medically indicated or necessary D. Physician billing for services provided by interns and residents. E. Giving health care providers inducements in exchange for referrals. C Lawsuits filed by private individuals under the False Claims Act are referred to as actions. C A. All of the above. B. Whistleblower C C. Relator C D. Qui Tam The Medicare Program:...
69) A policy that pays you back for actual expenses is called A) An indemnity plan. B) A deductible plan. C) A reasonable and customary plan. D) A reimbursement plan. E) A coinsurance plan m The set amount that you must pay toward medical expenses before the insurance company pays benefits is called A) Deductible. B) Reimbursement C) Indemnity. D) Internal limit. E) Reasonable and customary charges. 71) Which of the following is a government health care program? A) Health...
QUESTIONS 1. Which case-management strategy was used in this case study? Describe how. A. Utilization management B. Critical pathways C. Disease management D. Demand management Chapter 22: Case Management Student Case Studies Through a nurse's case-management activities, general community deficiencies in quality and quantity of health services are often discovered. When lack of care or services is observed at individual and family intervention levels, the nurse can, through case management, intervene at the community level to make changes. George S....
23. NAMI (National alliance for the mentally II) is a d professional organization for the mental health professionals b. advocacy group for the mentally ill factor that contributed siknificantly to deinstitutionalization of mentallyill atients was: a. The development of effective pharmacologic treatments b. Rising concern over the costs of inpatient care c. The Quaker movement for "moral treatment" 24. One reason why only a small percentage of those in need of mental health services actually receives them is: Mental health...
Identification and explanation of the main cost management
problem using the cost management theory,
a. Identification of (5) external or internal causes
that originates the proposed main cost management problem,
b. What should be Bay Area Health Network’s mission in
the context of the proposed main cost management problem and
internal and external causes?
c. Propose an adequate ABC analysis for Bay Area Health
Network’s situation to answer the questions presented in the
case
d. Define (5) cost management strategies...
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