Study for final exam
| Question | Answer |
|---|---|
| A significant contribution to HMO development was the… | Health Maintenance Organization Act of 1973 |
| When an HMO is paid a fixed amount for each patient served without considering the actual number or nature of services provided to each person, this is known as… | capitation. |
Is a PPG physician owned?
The difference between an IPA and a PPG is that a PPG may not be owned by its member physicians, whereas an IPA is physician-owned. In a point-of-service (POS) program, members may choose to use a non-program provider at any time. … it limits the patient’s choice of personal physicians.
What plan allows members of the Kaiser Permanente Medical Care Program to seek medical help from non Kaiser physicians quizlet?
What plan allows members of the Kaiser Permanente Medical Care Program to seek medical help from non-Kaiser physicians? Health Maintenance Organization Act of 1973.
What is the correct procedure to collect a copayment on a managed care plan?
Chap 11/12
| Question | Answer |
|---|---|
| What is the correct procedure to collect a copayment on a managed care plan? | Collect the copayment when the patient arrives for the office visit. |
| Medicare Part A is administered (run) by who? | The Center for Medicare and Medicaid Services. |
When a physician sees a patient more than is medically necessary it is called?
When a physician sees a patient more than is medically necessary, it is called. churning. Referral of a patient recommended by one specialist to another specialist is known as. tertiary care.
How are physicians who work for a prepaid group practice model paid group of answer choices?
Chapters 11, 12, 13, & 14
| Question | Answer |
|---|---|
| How are physicians who work for a prepaid group practice model paid? | salary paid by independent group |
| How does an HMO receive payment for the services its physicians provide? | fee for service |
What does PPG mean in healthcare?
Photoplethysmography Photoplethysmography (PPG) is an examination comparable to the ankle-brachial index except that it uses a very tiny blood pressure cuff around the toe and a PPG sensor (infrared light to evaluate blood flow near the surface of the skin) to record waveforms and blood pressure measurements.
What does PPG stand for in insurance?
Physician Group or Participating Physician Group (PPG) means the medical group the individual Member selected as the source of ELECT 1/HMO covered medical care.
What is indemnity medical?
Indemnity plans allow you to direct your own health care and visit almost any doctor or hospital you like. The insurance company then pays a set portion of your total charges. Indemnity plans are also referred to as fee-for-service plans.
What is the name of an organization of physicians sponsored?
health maintenance organizations (HMOs). An organization of physicians sponsored by a state or local medical association concerned with the development and delivery of medical services and the cost of health care. . What is a foundation for medical care?
What is the consequence when a medical practice does not use diagnostic codes quizlet?
what is the consequence when a medical practice does not use diagnostic codes? It affects the physician’s level of reimbursement for inpatient claims, claims can be denied and fines or penal ties can be levied.
What is the correct procedure to collect a co payment on a managed care plan quizlet?
what is the correct procedure to collect a copayment on a managed care plan? collect the copayment when the patient arrives for the office visit.
What are the two major differences between managed care and indemnity insurance?
Traditional Indemnity- insure pays a fixed monthly premium and 100% all bills till annual deductible then insurance pays up to maximum amount. Managed Care Plan- Pay monthly premiums, copays and sometimes deductible.
Which words would not be used to indicate a qualified diagnosis?
Do not code diagnoses documented as “probable,” “suspected,” “questionable,” “rule out,” or “working diagnosis,” or other similar terms indicating uncertainty.
Is an HMO a Medicare Advantage Plan?
A Health Maintenance Organization (HMO) plan is a type of Medicare Advantage Plan that generally provides health care coverage from doctors, other health care providers, or hospitals in the plan’s network (except emergency care, out-of-area urgent care, or out-of-area dialysis).
What should be considered when using a collection agency?
What characteristics should be considered when choosing a collections agent? Professional, ethical, and reliable. What is an insufficient funds charge? Nonsufficient funds: a check that is returned to a depositor because of a lack of funds in the payee account.
What is the term for the 10 digit number that identifies the provider’s medical specialty?
Taxonomy code. A 10 digit number that stands/represents for a physicians’ medical specialty. Service-line information. That part of the claim that reports procedures or services provided for the patient. National Provider Identifier (NPI)
What are the two most common types of electronic claim formatting used in the United States?
The two types of computer claims systems are clearinghouse and carrier-direct.
What is a prepaid group practice?
Prepaid group practices (PGPs) are complex organizations that directly combine prepayment for health care with a comprehensive health care delivery system. As such, Schoenbaum says, their ability to manage physician staffing efficiently must be placed in context with the cost and quality of their care.
Which type of referral is usually processed immediately?
Medical Insurance
| Question | Answer |
|---|---|
| The amount of money paid to keep an insurance policy in force is the: | premium |
| Which type of referral is usually processed immediately? | STAT |
| An established schedule of fees set for services performed by providers and paid by the patient is called an indemnity plan. | False |
What are the main characteristics of an HMO quizlet?
An HMO features managed care, prepaid services, co-pays, a gatekeeper primary care physician, a limited choice of providers, and a limited service area.
What is the abbreviation of PPG?
PPG
| Acronym | Definition |
|---|---|
| PPG | Pounds Per Gallon |
| PPG | Photoplethysmograph |
| PPG | Price per Gallon |
| PPG | Poly-Propylene Glycol |
What is the full form of PPG?
The Full Form of PPG is Points Per Game.
What does PPG stand for in dentistry?
2.5 Photoplethysmography Photoplethysmography (PPG), also known as the pulse oximeter waveform, is a simple and low-cost optical technique that can be utilized to detect blood volume changes in the microvascular bed of tissue. It is frequently employed noninvasively to take measurements at the skin surface.
What is ppg%?
Photoplethysmography (PPG) is a simple optical technique used to detect volumetric changes in blood in peripheral circulation. … The technique provides valuable information related to our cardiovascular system.
What does PPG mean in hockey?
Shooting percentage (goals divided by shots) The number of goals scored as a percentage of shots taken. PPG. Power-play goal. Goals scored while the other team is playing shorthanded.
What does BBG mean?
BBG is an acronym that means beautiful baby girl. better be going—a neutral, polite way to end a conversation that might otherwise continue.
How much does hospital indemnity insurance cost?
On average, hospital indemnity insurance premiums range from $50 to $400 a month. For the premium you pay, you receive a daily max payout based on the plan you choose.
How much does an indemnity plan cost?
The monthly cost of a hospital indemnity plan will depend on your plan choice, age, gender, and possibly your tobacco use. For example, plans that offer fewer benefits start at just under $7 per month. Plans that offer a wider range of benefits can vary anywhere from $19 up to $463 per month.
How does an indemnity work?
Indemnity is a contractual agreement between two parties. In this arrangement, one party agrees to pay for potential losses or damages caused by another party. … With indemnity, the insurer indemnifies the policyholder—that is, promises to make whole the individual or business for any covered loss.
Graduated from ENSAT (national agronomic school of Toulouse) in plant sciences in 2018, I pursued a CIFRE doctorate under contract with Sun’Agri and INRAE in Avignon between 2019 and 2022. My thesis aimed to study dynamic agrivoltaic systems, in my case in arboriculture. I love to write and share science related Stuff Here on my Website. I am currently continuing at Sun’Agri as an R&D engineer.