CHFP CARDS EXAM QUESTIONS AND ANSWERS WITH
COMPLETE SOLUTIONS 100% GUARANTEED PASS
Facility Providers
Hospitals
Skilled Nursing Facilities
Assisted Living Facilities
Home Health Agencies
Ambulatory Surgery Center
Professional Providers
Physicians
Pharmacists
Nurses
Allied Professional Providers (APPs) - PT, clinical social work, & others
Primary Care Physicians - Usually trained in:
Family Practice
General Practice
General Internal Medicine
Pediatrics
Primary Care Physicians role is viewed as:
,Coordinator of a patients care
Assessing a patient's condition
Referring a patient to a specialist physician
Specialists
Focus on in-depth training in special diseases, body systems, or types of healthcare services.
Since the majority of their work is done within a hospital facility, specialties of radiology,
anesthesiology, and pathology - along with emergency room physicians and hospitalits are referred to
as?
Hospital-based Physicians
Types of out-of-pocket payments by patients that can be required as part of a health insurance plan
are:
Deductibles
Co-payments
Coinsurance
Deductible
a predetermined amount that insured must pay each year before the insurance company will pay
Coinsurance
a percentage of the insurance payment amount that is paid by the patient, along with the amount paid
by the insurer.
Copayment
A flat amount that the patient pays at each time of service.
,Benefit Payment
Amount paid by the insurer to the provider after the claim is determined as appropriate.
Covered benefit
The services for which the insurer will pay.
Medicare
A federal program of health insurance for persons 65 years of age and older, persons with disabilities,
and persons with End Stage Renal Disease (ESRD).
Medicare Part A (aka Hospital Insurance or HI)
Provides hospital insurance automatically @ age 65 (if FICA qualified) @ no fee but may have deductible
& co-pay.
Categorical eligibility
Persons who have paid Medicare wage taxes for at least 40 calendar quarters. Part of only Medicare Part
A.
Medicare Part A Covers
Inpatient hospital services, certain organ transplants, ESRD treatment , inpatient skilled nursing facility
care, home health care and hospice care.
Lifetime Reserve
Medicare Part A after 180 days per spell of illness, the patient has a one-time bank of days to cover long
stays.
Medicare Part A Coverage for Hospital Stays
, o Cost of days 2 - 60 of a spell of illness or hospitalization
o Days 61-180 - the patient pays a coinsurance amount per day
o After 180 days, Medicare Part A stops & lifetime reserve may kick in
Medicare Part B
Voluntary program where a patient that meets the age or medical condition requirements for Medicare
Part A (but not the requirement to pay taxes for 40 calendar quarters) may participate in the insurance
benefit.
Funded by a combination of premiums paid by the beneficiary and general tax revenues from the federal
government.
Part B Only
Patients who are covered by Medicare Part B but not Medicare Part A.
Medicare Part C (Medicare Advantage)
•Replaces and covers expenses found in Part A and B
•Medicare private fee-for-service plans (PFFS)
•Medicare managed care plans (HMOs and PPOs)
•Medicare specialty plans
Medicare Part D Prescription Drug Coverage
a United States federal-government program to subsidize the costs of prescription drugs and prescription
drug insurance premiums for Medicare beneficiaries.
COMPLETE SOLUTIONS 100% GUARANTEED PASS
Facility Providers
Hospitals
Skilled Nursing Facilities
Assisted Living Facilities
Home Health Agencies
Ambulatory Surgery Center
Professional Providers
Physicians
Pharmacists
Nurses
Allied Professional Providers (APPs) - PT, clinical social work, & others
Primary Care Physicians - Usually trained in:
Family Practice
General Practice
General Internal Medicine
Pediatrics
Primary Care Physicians role is viewed as:
,Coordinator of a patients care
Assessing a patient's condition
Referring a patient to a specialist physician
Specialists
Focus on in-depth training in special diseases, body systems, or types of healthcare services.
Since the majority of their work is done within a hospital facility, specialties of radiology,
anesthesiology, and pathology - along with emergency room physicians and hospitalits are referred to
as?
Hospital-based Physicians
Types of out-of-pocket payments by patients that can be required as part of a health insurance plan
are:
Deductibles
Co-payments
Coinsurance
Deductible
a predetermined amount that insured must pay each year before the insurance company will pay
Coinsurance
a percentage of the insurance payment amount that is paid by the patient, along with the amount paid
by the insurer.
Copayment
A flat amount that the patient pays at each time of service.
,Benefit Payment
Amount paid by the insurer to the provider after the claim is determined as appropriate.
Covered benefit
The services for which the insurer will pay.
Medicare
A federal program of health insurance for persons 65 years of age and older, persons with disabilities,
and persons with End Stage Renal Disease (ESRD).
Medicare Part A (aka Hospital Insurance or HI)
Provides hospital insurance automatically @ age 65 (if FICA qualified) @ no fee but may have deductible
& co-pay.
Categorical eligibility
Persons who have paid Medicare wage taxes for at least 40 calendar quarters. Part of only Medicare Part
A.
Medicare Part A Covers
Inpatient hospital services, certain organ transplants, ESRD treatment , inpatient skilled nursing facility
care, home health care and hospice care.
Lifetime Reserve
Medicare Part A after 180 days per spell of illness, the patient has a one-time bank of days to cover long
stays.
Medicare Part A Coverage for Hospital Stays
, o Cost of days 2 - 60 of a spell of illness or hospitalization
o Days 61-180 - the patient pays a coinsurance amount per day
o After 180 days, Medicare Part A stops & lifetime reserve may kick in
Medicare Part B
Voluntary program where a patient that meets the age or medical condition requirements for Medicare
Part A (but not the requirement to pay taxes for 40 calendar quarters) may participate in the insurance
benefit.
Funded by a combination of premiums paid by the beneficiary and general tax revenues from the federal
government.
Part B Only
Patients who are covered by Medicare Part B but not Medicare Part A.
Medicare Part C (Medicare Advantage)
•Replaces and covers expenses found in Part A and B
•Medicare private fee-for-service plans (PFFS)
•Medicare managed care plans (HMOs and PPOs)
•Medicare specialty plans
Medicare Part D Prescription Drug Coverage
a United States federal-government program to subsidize the costs of prescription drugs and prescription
drug insurance premiums for Medicare beneficiaries.
