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 Juan expect?

Dr. Jones is a podiatrist who performs over 100 bunionectomies a year. Several of Dr. Jones’ patients are insured by Super Payer. Super Payer reimburses Dr. Jones one amount for the preoperative visit, the surgery, and routine post-operative follow-up visits. Which reimbursement methodology does Super Payer use to reimburse Dr. Jones?

What is the term for the set fee that a policyholder or certificate holder must periodically pay a health insurance plan in return for healthcare coverage?

In states where there is not a mandated fund for workers’ compensation, which of the following is an option for employers?

Wes is enrolled in Medicare Part A. He had his first hospital encounter this March. He was admitted for congestive heart failure and stayed three days? Which of the following will Wes need to pay?

____ is a federal program, state administered…. that provides health care coverage to low income populations and certain aged and disabled individuals

. All of the following activities are steps in medical necessity and utilization review except:

What is the main goal of the CMS-HCC risk adjustment model?

Insurance policies include procedures for determination of other party liability (OPL). When a(n) _________ is involved, the insurance company will need to perform a determination of other party liability

When a provider bills separately for procedures that are a part of the major procedure, this is called