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Select 3 of the following EDI transactions that are processed in the format established by the Health Insurance Portability and Accountability Act (HIPAA) A Order management B Eligibility C Release of Information D Consent forms E Claims status F Payment and remittance advice

How does the Health Insurance Portability and Accountability Act (HIPAA) facilitate electronic transactions?

Traditional indemnity policies reimburse the insured based on the [amount charged | usual, customary, and reasonable (UCR) charges] for the medical services received. a. amount charged b. usual, customary, and resonable (UCR) charges

What is a contractual adjustment? How does a health care organization account for a contractual adjustment?

Which of the following statements regarding the Patient Protection and Affordable Care Act (ACA) is true?   Group of answer choices a. The ACA eliminates lifetime limits on total health care insurance payments by insurers. b. The ACA limits the total number of surgeries for the insurers. c. The ACA requires employers to reimburse the cost of hospital stays of the insured. d. The ACA decides the insurance payments for dependents. e. The ACA provides major medical insurance with low deductibles to protect against catastrophic illnesses.

Activities of daily living (ADLs) are important in determining _____ for long-term-care insurance.   Group of answer choices a. type of care b. services covered c. the waiting period d. eligibility e. benefit duration

An important distinction in health insurance is between the list price (PL) and out-of-pocket price (PP) of a medical good or service. The list price is the official price that the provider charges the insurance company, while the out-of-pocket price is the price that the insurance customer faces. Sometimes, the out-of-pocket price depends on the list price.   Now assume the consumer is part of a partial insurance plan with a coinsurance provision. Her insurance pays 50% of all medical expenses. Consider again the relationship between PL and PP and plot a coinsurance plan demand curve in PL - Q space. Label this curve D3. Finally, assume the consumer is part of a partial insurance plan with a copayment provision. Her insurance pays all expenses above and beyond her copayment of $25 for each unit of Q. Consider again the relationship between PL and PP and plot a copayment-plan demand curve in PL - Q space. Label this curve D4.

Examples of health insurance offsets include all of the following, EXCEPT: a) Co-pays b) Deductibles c) Co-insurance d) Preventive programs

Please describe factors that influence the financial viability of a healthcare organization and discuss the major aspects of Medicare benefits? and how do legal and regulatory issues shape and define the good financial management of an HCO?

With respect to employer-sponsored health insurance plans, the amount of money a covered participant must pay before health insurance benefits become active is known as which of the following? Select one: a. Premium b. Safe harbor c. Deductible d. Coinsurance

Health maintenance organizations (HMOs) provide health care to participants without requiring them to file insurance claims. a. True O b. False

Course Name: Principle of Healthcare Finance   How does Medicare reimburse physician services?

Which type of insurance is not deductible as self-employed health insurance? a. Long-term care insurance O b. Medical insurance Oc. Disability insurance Od. Dental insurance Oe. Spousal medical insurance

If I bill customer for patient services what is that called

Which is Idemenity Plan and which is Managed Care Plan? Insureds create contract with an insurer who does not provide health care services       The higher the deductible, the lower the premium       Insured receive health care services from a designated group of providers       May not even involve an insurance company       No annual deduction is incurred, but a small co-payment may be required I most value the freedom of choice and am willing to pay for it.       Cost is my most important consideration.       I’d rather have the flexibility of either having the insurance company reimburse me or directly paying the health care provider.

Course Name: Principle of Healthcare Finance How does Medicare reimburse hospitals for inpatient stays?