One of the Criteria for Scaling Compensable Factors Is to Ensure

question 27

True/False

One of the criteria for scaling compensable factors is to ensure that the number of degrees used is necessary to distinguish among jobs.

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Definitions:

Capitation

The health care provider is paid a fixed amount per member per month for each patient who is a member of a particular insurance organization regardless of whether services were provided.

Precertification

Refers to obtaining plan approval for services prior to the patient receiving them; refers to seeking approval for a treatment (surgery, hospitalization, diagnostic test) under the patient’s insurance contract.

Specified Outpatient

Specified Outpatient refers to particular outpatient medical treatments or procedures that are predefined under a health plan or policy for coverage or reimbursement.

Coordination of Benefits (COB)

A process in health insurance to determine the order of responsibility when a person is covered by more than one insurance plan, to avoid overlapping payments.