What is it called when Medicare forwards a claim to the secondary insurance?
What will be an ideal response?
Ans:
Coordination of benefits” is the term used to refer to the process Where the respective obligations to pay for a claim are calculated and determine when an individual that receives care is covered by two separate insurance or other benefit programs. These rules are governed by federal mandates. Medicare dictates that employer sponsored plans and certain other coverages be treated as primary and pay benefits first before Medicare pays benefits under certain circumstances were the individual is over age 65, disabled, or suffers from an stage renal disease. When the coverage is provided by a state regulated insurance product, state insurance law generally imposes mandates for determining what plan is primary and secondary as well. Where these rules don’t apply, such as in self-insured employers sponsored plans, the plan document typically will govern subject to the federal mandates for Medicare, Medicaid, and certain other government programs.
You might also like to view...
The patient has experienced a toxic inhalation injury that has damaged his type II alveolar cells significantly. The nurse should expect to find which of the following?
A) Impaired gas exchange and atelectasis B) Bronchospasm and wheezing C) Laryngospasm and stridor D) Eupnea and bradycardia
A nurse is performing an admission assessment on a patient with stage 3 HIV. After assessing the patient's gastrointestinal system and analyzing the data, what is most likely to be the priority nursing diagnosis?
A) Acute Abdominal Pain B) Diarrhea C) Bowel Incontinence D) Constipation
Dashboards and balanced scorecards can be used to identify four perspectives of an organization. Which of the following are some of these perspectives? Select all that apply
a. customer satisfaction c. finances b. staff satisfaction d. learning and growth
Before administering the continuous nasointestinal tube (NIT) feeding, the nurse verifies placement of the client's NIT and flushes it with water. Which should the nurse implement next?
1. Instill the formula at room temperature. 2. Infuse the formula over 10 to 15 minutes. 3. Raise syringe feet above insertion site. 4. Attach feeding bag to proximal end of NIT.