Healthcare Reimbursement Final UPDATED Exam Questions and CORRECT Answers
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Course
Healthcare Reimbursement
Institution
Healthcare Reimbursement
Healthcare Reimbursement Final
UPDATED Exam Questions and
CORRECT Answers
There are 3 parties in healthcare reimbursement. Who is the first party? - Correct AnswerPatient or guarantor
Which type of reimbursement methodology is associated with the abbreviation "PMPM"? -
Correct Answer- Capita...
Healthcare Reimbursement Final
UPDATED Exam Questions and
CORRECT Answers
There are 3 parties in healthcare reimbursement. Who is the first party? - Correct Answer-
Patient or guarantor
Which type of reimbursement methodology is associated with the abbreviation "PMPM"? -
Correct Answer- Capitated payment
What is an example of a charge that usually would be reviewed by an HIM coder? - Correct
Answer- Claim is failing due to potentially incomplete code, including missing modifiers.
Which of the following coding systems was created for reporting procedures and services
performed by physicians in clinical practice? - Correct Answer- CPT
What impact does a hospital acquired condition have on a hospital's Medicare
reimbursement? - Correct Answer- If a hospital acquired condition causes a case to be
grouped to a higher paying DRG, Medicare will only reimburse for the lower paying DRG.
In the healthcare insurance sector, what does UCR stand for? - Correct Answer- Usual
Customary and Reasonable
Which statement describes the per diem payment method? - Correct Answer- Fixed rate for
each day a covered member is hospitalized
Which discounted fee-for-service healthcare payment method does Medicare use to
reimburse physicians? - Correct Answer- RBRVS
Which type of RAC review combines data analysis and submission of medical records to the
RAC? - Correct Answer- Semi-automated
In the healthcare industry, what is the term for receiving compensation for healthcare services
that were previously provided? - Correct Answer- Reimbursement
,To which of the following factors is health insurance status most closely linked? - Correct
Answer- Employment
What is the optimum chart completion window for revenue cycle purposes? - Correct
Answer- Within the bill hold period
Which of the following is the correct format for HCPCS Level II codes? - Correct Answer-
A1234
In the United States, what is healthcare insurance? - Correct Answer- Reduction of a person's
or a group's exposure to risk for unknown healthcare costs by the assumption of that risk by
an entity
In the healthcare industry, what is another term for "fee"? - Correct Answer- Charge
What is the purpose of a random audit of coded data? Select all that apply. - Correct Answer-
Quality monitoring
Which of the following entities does not perform improper payment reviews for CMS? -
Correct Answer- None of the above
QIO
CERT
RACs
MACs
Which of the following payment methods are global? - Correct Answer- Correct All of the
above
Answers:
, Block grants
Surgical packages
Bundling
Correct All of the above
Which of the following is an example of fraud? - Correct Answer- Billing for a service not
furnished as represented on the claim
Which patient registration error can appropriately be corrected by HIM coders, if permitted
by policy and procedures? - Correct Answer- Admission date
Which is an example of a practice that will most likely result in late charges? - Correct
Answer- Due to low volume, radiation oncology collects their charges and posts once a week.
True or False? The constant trend of increased national spending on healthcare is a concern
because as spending on healthcare increases, the money available for other sectors of the
economy decreases. - Correct Answer- True
You have reviewed the OIG work plan for the coming year and note several coding issues
that you want to make sure are accurately addressed by your coders. What is your first plan of
action? - Correct Answer- Targeted review
Which national model for the delivery of healthcare services is financed by general revenue
funds from taxes? - Correct Answer- National health service (Beveridge) model
Why do health insurers pool premium payments for all the insureds in a group and use
actuarial data to calculate the group's premiums? - Correct Answer- To assure that the pool is
large enough to pay losses of the entire group
Which of the following is not a common cause of improper payments? - Correct Answer-
Implementation of a documentation improvement program
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