All of the following types of procedures and services typically require prior authorization except

1. Patient 72341 is admitted as an inpatient for delivery. Length of stay is three days. The charges for the encounter are $10,425.00. The cost of the encounter is $5,848.45. Which payer will reimburse the hospital the highest amount? (blank 1) 2. Patient 89423 is seen in the outpatient clinic at Happy Hospital for a pneumonia follow-up visit. The charges for the encounter total $135. Which payer will reimburse the hospital the lowest amount? (blank 2) 3. Patient 24571 is seen in the Occupational Therapy (OT) clinic for an initial evaluation of her carpal tunnel surgery recovery. The charges for the visit total $150. Which payer will reimburse the facility the highest amount? (blank 3) 4. Patient 62316 is admitted as an inpatient for hip replacement following a fall on ice in the school parking lot where he works as a teacher. During his admission, the patient received OT services post-surgery. The LOS was six days. The charges for the encounter are $135,000. Which payer will reimburse the hospital the highest amount? (blank 4) a. Payer A b. Payer B c. Payer C d. Payer D e. There is not enough information in the contract matrix to determine reimbursement for this encounter  

Which government-sponsored program provides coverage for active-duty service members of the armed forces (ADSM)?

A bundled payment that covers all services from immediately prior to a surgical procedure through the appropriate post-procedure care period is known as _________

Dr. Ward is an endocrinologist who is part of the City Endocrinologist Specialists practice. Super Payer reimburses City Endocrinologist Specialists $450 per month for each of the 250 beneficiaries assigned to their care. Which type of reimbursement methodology is Super Payer using to reimburse City Endocrinologist Specialists?

What is the payment for services already provided. This is the correct answer

Which of the following is a key factor in establishing highly ethical culture promotes honesty and openness?

Dr. Gilbert 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 first party in this healthcare reimbursement scenario? (Answer in blank 1) a. Patient b. Parents c. Dr. Gilbert d. Insurance company Who is the second party in this healthcare reimbursement scenario? (Answer in blank 2) a. Patient b. Parents c. Dr. Gilbert d. Society Who is the third party in this healthcare reimbursement scenario? (Answer in blank 3) a. Patient b. Parents c. Insurance company d. State Department of Treasury

All of the following functions are ways that MCOs work toward their goal of controlling cost except:

The _______________ is a statement sent to the provider to explain payments made by third party payers.