HSA 305 Quizzes 1-4 - Quesions and Answers

HSA 305 Quizzes 1-4 - Quesions and Answers Dr. Jones sees a 15-old-male with adolescent idiopathic thoracic scoliosis. Surgery for spinal fusion was cancelled after the patient was diagnosed with mononucleosis. On today's visit the patient is started on prednisone for severe sore throat and difficulty swallowing. The patient was accompanied by his parents who have health insurance through the mother's employment at the State Department of Treasury. Who is the first party in this healthcare reimbursement scenario? Parents Which of the following is not a principle of revenue integrity? No oversight In this healthcare delivery model, employees and employers contribute an income-based amount of money to funds that are regulated by the government: Social Insurance Model Which of the following is not a component of the revenue cycle? Registration calculation A physician office submitting an invoice (claim) for payment when the patient has health insurance is an example of a transaction between ________ and ________. Provider; third-party payer In this delivery model, the insurance company determines that contribution amount that is not based on the policyholder's income: Private health insurance model Dr. Gilbert sees a 17-old-male with adolescent idiopathic thoracic scoliosis. Surgery for spinal fusion was cancelled after the patient was diagnosed with mononucleosis. On today's visit the patient is started on prednisone for severe sore throat and difficulty swallowing. The patient was accompanied by his parents who have health insurance through the mother's employment at the State Department of Treasury. Who is the third party in this healthcare reimbursement scenario? Insurance company Dr. March sees a 14-old-male with adolescent idiopathic thoracic scoliosis. Surgery for spinal fusion was cancelled after the patient was diagnosed with mononucleosis. On today's visit the patient is started on prednisone for severe sore throat and difficulty swallowing. The patient was accompanied by his parents who have health insurance through the mother's employment at the State Department of Treasury. Who is the second party in this healthcare reimbursement scenario? Dr. March The goal of revenue integrity is to produce a claim that is __________. Clean, complete, and compliant In this healthcare delivery model, the government is the only payer that funds universal healthcare coverage through taxes: National health service model Successful RCM programs use this type of approach, which promotes collaboration among various clinical departments and emphasizes in education strategy for all members: Multidisciplinary model A worker had group health insurance coverage through her employer. The workers household included her spouse, two natural children (ages 28 and 12 ), and adopted child (age 8 ), and the workers mother (age 58). Who may be included under dependent coverage in the health insurance policy? Spouse; natural child, age 12; and adopted child, age 8 All of the following functions are ways that MCO's work toward their goal of controlling costs except: Use of evidence based clinical practice guidelines All of the following occurrences are considered "qualifying life events" except: Car accident Juan belongs to a managed care plan. He wants to make an appointment with an out of network specialist. The plan has approved the appointment as "out of network." What should one expect? The patients' out of pocket costs will be increased. Jung Hwa Was married on July 1st, 20XX. She had worked