Fee-for service or managed care:which has higher copays and deductibles?

Answers

Answer 1

Explanation:

I’ll describe this in simplest terms. Things can be considerably more complex that this, and many reimbursement model variants exist in between these two “extremes”

Fee for Service : the provider (e.g. doctor or hospital) bills the insurer. The insurer adjudicates the claim, and reimburses the provider at rates that have been agreed upon by the two, less any portions for which the patient is held responsible per the terms if their policy.

(Large provider organizations may negotiate their own reimbursement schedules with insurers. Smaller ones mostly just make “take it or leave it” decisions on whether or not they want to accept the insurer’s members as patients, based on whether the insurer’s reimbursement rates appear acceptable to them in light of how badly they need access to the insurer’s supply of patients.)

In this model, all risk is carried by the insurer and its members. The insurer’s risk is that its members will require care for which it must pay out as just described. The members’ risk consists of how much they might have to pay in the form of deductibles, co-payments, and coinsurance if they require care. The providers mostly avoid risk because even if they end up treating a particularly expensive mix of patients, their revenue will go up accordingly.

Capitation : the provider is compensated primarily by a flat amount - the ‘capitation amount’ - that the insurer pays to them, per member/per month. Typically there will also be co-pays that are the responsibility of the member/patient. Then it is up to the provider to do its best to manage how it treats its cap patient population so that its costs of caring for them do not exceed the corresponding cap income.

In this model, considerable risk has been shifted to the provider. (Not all of it. There typically are provisions in the insurer-provider agreement that shift risk back to the insurer in circumstances of high patient utilization beyond the provider’s control. As previously noted, there can be many variants. And of course the member/patients still bear some risk with the copays etc.). This model creates incentive for the provider to think and act like they are “part provider, part insurer”. It is an “in between” model that stops short of the providers and insurer becoming one-and-the-same business (like Kaiser is, for example).

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Related Questions

How are food-contact surfaces to be handled between uses

A. Wash, rinse, and sanitize
B. Wipe down with cleaner
C. Clean and rinse
D.Wipe down with cleaner and sanitize

Answers

Answer:

B. Wipe down with cleaner

Wash, rinse, and sanitize is the correct order to be handled for food-contact surfaces, option A is correct.

Food-contact surfaces should be properly handled between uses to maintain cleanliness and prevent the spread of bacteria and contaminants. The recommended procedure involves a three-step process: washing, rinsing, and sanitizing. First, the surface should be washed with hot water and a suitable detergent to remove visible dirt, grease, and residue. After washing, the surface should be thoroughly rinsed with clean water to remove any remaining soap or detergent.

Finally, to ensure proper sanitation, the surface should be treated with an approved sanitize solution, such as a chlorine or quaternary ammonium compound, following the manufacturer's instructions. This final step kills any remaining bacteria or pathogens, making the surface safe for food contact. This comprehensive approach helps maintain hygiene and prevents cross-contamination in food preparation areas, option A is correct.

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Which statement BEST describes antibiotic resistance?


Antibiotic resistance occurs when the body builds up a resistance to antibiotics.

Antibiotic resistance can occur when bacteria are exposed to an antibiotic.

Antibiotic resistance occurs when antibiotics are not used.

Antibiotic resistance is a big problem in the United States, but not the world.

Answers

I would say "when bacteria are exposed to an antibiotic" but just so you know, it has to be exposed several times before it developes resistance.

What generations are considered older adults?

Answers

I think the boomer generation

Answer:

GEN X

Explanation:

people 41-56 (1965-1980) are considered generation X

people born between 1955 – 1964 are considered boomers aged between 57 and 66

Boomers I 1946 – 1954 aged 67 – 75

ans Post War 1928 – 1945 aged 76 – 93

finally... WW II 1922 – 1927 aged94 – 99

Hope this helped you- have a good day bro cya)

How can inequality make us ill?

Answers

Answer:

yes

Explanation:

Can inequality make us ill? Poor health and poverty do go hand-in-hand. But high levels of inequality, the epidemiological research shows, negatively affect the health of even the affluent, mainly because, researchers contend, inequality reduces social cohesion, a dynamic that leads to more stress, fear, and insecurity for everyone.


Provide an example of when a disability service worker may seek
support from more experienced and qualified staff?

Answers

Explanation:

job injury is the no.1 cause of healthcare workers needing PT + BUILDING MUSCLE 2 support injury...

Using the results from your pre-fitness assessment, write a three-paragraph reflection addressing the following questions. Be sure to address all portions of the prompt of the questions in your reflection. Journal prompt to be answered in 3 fully developed paragraphs citing specific examples from the pre-assessment. In paragraph 1, summarize your results for each part of the assessment. Were there areas that surprised you about your results(able to complete more or less than you thought)? In paragraphs 2 and 3, respond to the following: What is the purpose of completing a pre-assessment? How can you analyze the data and use it to create a plan? What areas of the assessment would like to improve upon?

Answers

Based on the information given, it should be noted that pre-assessments are the methods that are used to determine the knowledge and skills of athletes or students.

Your information is incomplete as the result of the pre-fitness assessment isn't included. Therefore, an overview will be given. Pre-fitness assessment are used in measuring the physical level of students or athletes.

It should be noted that they are important as they provide teachers or coaches with the appropriate data to understand the student's fitness.

This is important to enable the teacher or coach to know where to begin instructions. The best way to analyze the assessment information is to simply present the data in relation to the goals of the program.

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What is the best treatment protocol for Major Depressive Disorder and Schizophrenia?

Answers

Considering schizophrenia, antipsychotics are the most common treatment and have demonstrated good efficacy. Still, side effects of these treatments are commonly reported and may impact adherence to the medication and functioning in patients with schizophrenia.

Which statement describes the movement of water when a cell swells up and bursts due to osmosis?
® Water went into the cell because the concentration of water inside the
cell was lower than the concentration
outside the cell.
Water went out of the cell
outside the cell.
becayse the concentration of water inside the cell was
higher than the concentration
C The cell membrane used energy to move water into the cell through passive transport.
The cell membrane used energy to move water out of the cell through passive transport.

Answers

Answer:

A. Water went into the cell because the concentration of water inside the

cell was lower than the concentration

outside the cell.

Explanation:

Osmosis occurs when there is low solute concentration to a higher solute concentration, thus the water outside the cell (having low concentration), would want to go inside the cell where there is a higher concentration. Hope this helps!

Your friend tells you that she recently went to see a psychologist and while in the psychologist's office, the psychologist asked her to relax and say whatever comes to mind. Based on this information, what is most accurate?

Answers

The psychologist's attitude of asking his friend to relax and say whatever comes to his mind can be understood as part of the treatment of humanistic and behavioral psychotherapy.

The humanistic and behavioral psychotherapy approach aims to help an individual resolve emotional issues such as anxiety and depression based on the individual's process of talking and sharing their feelings and emotions.

Through the patient's speech, the psychologist is able to identify behavior patterns and negative habits that can impact the individual's quality of life, identifying the roots of the problem and seeking constructive solutions to solve them.

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2. What is the main reason kettlebells have become so popular?

They come in different colors.

They allow a person to more closely mimic real movement.

They come in a larger variety of weights.

They have a handle​

Answers

Answer:

"They allow a person to more closely mimic real movement:

the level for coding a patient's history include what?

Answers

Answer:

Evaluation and management coding is a type of medical coding used by physicians and certain other healthcare providers to report their services as part of medical billing. Evaluation and management (E/M) codes are found in the CPT® code set in the range 99202-99499 and cover a variety of services. Many E/M codes, such as those for inpatient care and home visits, include a combination of patient history, examination, and medical decision making (MDM).

These factors — history, exam, and MDM (HEM) — are known as the three key components of E/M level selection. Determining the correct type of history, exam, and MDM can feel intimidating even for seasoned coders because of the many requirements involved. A solid understanding of these three key components will help ensure more accurate coding and reimbursement for E/M codes.

1. determine the type of history . A patient history includes getting the chief complaint and the history of the present illness. The history also may include a review of body systems using questions to identify signs and symptoms, and a review of the patient’s past, family, and social history, depending on what is medically appropriate for the visit. The amount of history taken will determine the type: problem focused, expanded problem focused, detailed, or comprehensive.

2. determine the type of the physical exam. The provider uses clinical judgment to determine the extent of physical examination needed for each of the patient’s body areas and organ systems. The provider will document one of these four types of exam: problem focused, expanded problem focused, detailed, or comprehensive.

3. determine the type of medical decision making (MDM). MDM is how the provider rates the degree of difficulty in establishing a patient’s diagnosis and treatment plan. E/M codes include four types of MDM: straightforward, low complexity, moderate complexity, and high complexity.

4.determine the final code. Once the provider has determined the types of history, exam, and MDM, final E/M code selection can occur based on those three key components. For this example, assume the physician performed a comprehensive history, a comprehensive exam, and medical decision making of high complexity for this new patient. The appropriate code in this case is 99328 Domiciliary or rest home visit for the evaluation and management of a new patient, which requires these 3 key components: A comprehensive history; A comprehensive examination; Medical decision making of high complexity.

Explanation:

can you get food poisoning from people?

Answers

You can get food poisoning from PEOPLE who COOK the food. But not from people, the actual word gives it away as to where and how good poisoning is given.

Arrange the parts of the respiratory tract in a sequence that accurately represents the flow of air after a person inhales.
pharynx
trachea
bronchi
nasal cavity
larynx










Reset Next

Answers

Answer:

Pharynax, Nasal Cavity, Bronchi, Larynx, Trachea.

Explanation:

Trust me i did this test already.

why FITT principles are important in our life?​

Answers

Answer:

Regardless of your experience level, F.I.T.T helps ensure that your body reaps the full benefits of regular workouts. By the same token, it protects you from eventual exercise burnout.

Hope that helps. x

What vitamin is neither fat nor water soluble

Answers

Vitamin H is neither fat nor water soluble
Vitamins A, D, E, and K
Unlike water-soluble vitamins, fat-soluble vitamins are stored in the body when they are not in use.

what word means: the confidence and worth that you feel
about yourself.

Answers

Answer:

Yes.

Explanation:

Because confidence is a word.

Are most domestic abusers

Narcissists or sociopaths

Answers

Answer:Narcissists they only think about themselves

Explanation:

In swine reproduction, how many females can a yearling boar service?

A: 10
B: 15
C: 20
D: 25

Answers

Answer should be C- 20 females

how can we control our emotion and mind set in positive way?​

Answers

Answer:

Journaling your emotions each day can help you sort through positive and negative reactions. Relaxation and breathing techniques are a common management technique that can help with all emotions. Living a healthy lifestyle can also contribute to the ability to control emotions.

Social Responsibility Towards Consumers

Answers

Answer:

The responsibility towards consumers that Corporate Social Responsibility includes is as follows: To provide goods of standard quality. To charge fair prices. To provide prompt and courteous after sale services.


Peaking at 14 to 15 years of age,_____
executive function includes psychological processes driven by emotion, with emotion regulation an especially important process

Answers

What the first one said

Alan is a behavior analyst consulting with a family on helping Cam their seven year old son go to bed without tantrums. Right now her tantrums last two to three hours and it is keeping the whole family awake at night. He interviews the family, collects ABC data, collects scatterplot data, and after collecting the data schedules a second interview with the family as part of the conjoint behavioral consultation course. In this interview, they willl look at the data collected, talk about what the hypothesized function of the behavior is , as well as collaboratively develop an intervention plan. Which interview in the CBC process are they going to have?

Answers

Considering the situation described above, the second interview in the CBC process they will have is the "Conjoint Needs Analysis."

What is Conjoint Needs Analysis?

Conjoint Needs Analysis is the second stage or interview in the Conjoint Behavioral Consultation that involves formulating solutions over established settings based on gathered behavioral

data.

Given that Alam has collected ABC data and scatterplot data, the following or second interview is the Conjoint Needs Analysis.

The Conjoint Behavioral Consultation process is in four stagesConjoint Needs IdentificationConjoint Needs AnalysisPlan ImplementationConjoint Plan Evaluation

Hence, in this case, it is concluded that the correct answer is "Conjoint Needs Analysis."

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Which of the following would NOT be considered unfair discrimination?

Answers

Answer:

Which of the following would NOT be considered unfair discrimination?

Explanation:

Ummm... You didn't specify of what or give a list so I am unsure of what to do please get back to me.

Discriminating in benefits and coverage based on the insured’s habits and lifestyle is not an example of unfair discrimination.

A discrimination is said to be unfair when it is;

UnwarrantedUnjustifiedBased on bias

Hence, if these are the characteristics of unfair discrimination, then it follows that discriminating in benefits and coverage based on the insured’s habits and lifestyle is not an example of unfair discrimination.

Missing parts;

Which of the following will NOT be considered unfair discrimination by insurers?

a)Assigning different risk classifications to applicants based on gender identity

b)Discriminating in benefits and coverages based on the insured’s habits and lifestyle

c)Charging applicants with similar health histories different premiums based on theirethnicity

d)Cancelling individual coverage based on the insured’s marital status

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Nurse Jane is preparing to interview someone with influenza. What is the MOST appropriate PPE for her to use?GlovesGownMaskN95 respirator

Answers

Given what we know about proper safety measures, we can confirm that if Nurse Jane is preparing to interview someone with influenza, she should use an N95 respirator.

What is an N95 respirator?an N95 respirator is a face mask. It is the most advanced form of face mask that is readily available to the public.This type of mask uses a series of filters, along with a charged metallic net on the inside to ensure that virtually no particles of any kind can penetrate. For these reasons, the N95 respirator offers an effective protection against highly contagious viruses such as influenza

Therefore, given that influenza is a virus that can survive suspended in the air for hours, making it very easier to become infected through breathing infected air, the most appropriate PPE for Nurse Jane to use is an N95 respirator to protect against this situation.

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blood flows through your body to the where it gets new oxygen
a. liver
b. kidney
c. lungs

Answers

Answer:

lungs

Explanation:

goes from the heart to the lungs to get oxygen

During which phase of the Estrous Cycle does the female become restless and exhibit signs of being in heat?

A: Diestrus
B: Estrus
C: Metestrus
D: Proestrus

Answers

Answer:

Explanation:

B

Which of the following are used to administer liquid medications orally? O a) Syringes b) Vials c) Suppositories d) Droppers e) Teaspoons

does Light olive oil has fewer calories than extra virgin olive oil.

Answers

No extra virgin olive oil is purer then light olive oil which might or might not have chemicals in it from off brands.
What equipment is generally used to make lyophilized medications suitable for administering to the patient? a) Test tubes or sterile ampules O b) Petri dishes and sterile droppers c) Sterile syringes or graduated cylinders d) Measuring cups and clean, warm water

Explain when you should seek treatment for depression

Answers

When depression begins to affect daily life and makes problems in participating in daily activities then medical help and treatment should be sought. This condition is referred to as a major depression. This depression is characterized by a persistent feeling of sadness and a lack of interest in the environment and other people.

Answer:

When depression begins to affect the daily life and makes problems in participating in daily activities than medical help and treatment should be seeked. This condition is referred to as major depression. This depression is characterized by a persistent feeling of sadness and a  lack of interest fro the environment and other people.

Explanation:

Amanda has started running as her primary form of exercise, but she's getting bored with it and finds excuses to procrastinate. It's also getting really hot outside now that it's summer, and Amanda's skin is sensitive to the sun. She has a significant budget available to help her fix the problem but is unsure how to spend the money. What might be the most appropriate purchase for Amanda?

A device that checks blood glucose and pairs with an app that evaluates sugar intake per meal
An activity tracking tool that pairs with an app to calculate calorie intake and calories burned
An app that features menu planning with healthy recipes and pairs with a calorie tracking tool
An exercise video g

Answers

Answer:

B

Explanation:

Bing Bong Bing Bong

Which behavior is most likely to indicate alcohol use

Answers

Anger! People whom are drinking tend to get mad at simple things and scream!

Explanation:

sluring or words, the smell of alcohol, stumbling/tripping, eyes super glossy, and can't stand up straight

hope this helps :)

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