HSA 305 EXAM 1 QUESTIONS AND ANSWERS
Successful RCM programs use this type of approach, which promotes collaboration amount various
clinical departments and emphasizes and education strategy for all members: - CORRECT
ANSWER✅✅multidisciplinary model
Premium - CORRECT ANSWER✅✅amount of money that must be periodically paid to a health insurance
company in return for healthcare coverage
Guarantor - CORRECT ANSWER✅✅Person who is responsible for paying the bill for healthcare services
Revenue Cycle - CORRECT ANSWER✅✅the process of completing all the steps that the facility or
provider must take to ask for reimbursement from the payer and to ensure that the received payment is
correct
Reimbursement - CORRECT ANSWER✅✅The amount paid to a healthcare provider for services
provided to a patient.
Third party payer - CORRECT ANSWER✅✅Insurance company or health agency that pays the provider
for the care or services provided to the patient
Insurance - CORRECT ANSWER✅✅reduction of a person's exposure to risk of loss by having another
party assume the risk
Beneficiary - CORRECT ANSWER✅✅An individual who is eligible for benefits from a health plan
Risk pool - CORRECT ANSWER✅✅group of individuals or entities who have a similarly risk of loss
Policyholder - CORRECT ANSWER✅✅individual who purchases health insurance coverage
Dr. Gilbert sees a 17-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 third party in this healthcare reimbursement scenario - CORRECT ANSWER✅✅Insurance
Company
In this healthcare delivery model, the government is the only payer that funds universal healthcare
coverage through taxes: - CORRECT ANSWER✅✅National Health service model
Dr. Jones sees a 15-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 - CORRECT ANSWER✅✅Parents
In this healthcare delivery model, employees and employers contribute an income-based amount of
money to funds that are regulated by the government - CORRECT ANSWER✅✅Social Insurance Model
Which of the following is not a principle of revenue integrity? - CORRECT ANSWER✅✅No oversight
Which of the following is not a component of the revenue cycle? - CORRECT ANSWER✅✅Registration
calculation
In this delivery model, the insurance company determines the contribution amount that is not based on
the policyholder's income? - CORRECT ANSWER✅✅Private Health Insurance Model
A physician office submitting an invoice (claim) for payment when the patient has health insurance is an
example of a transaction between _____ & ______ - CORRECT ANSWER✅✅provider, third-party payer
Dr. March 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 second party in this healthcare reimbursement scenario - CORRECT ANSWER✅✅Dr. March
Successful RCM programs use this type of approach, which promotes collaboration amount various
clinical departments and emphasizes and education strategy for all members: - CORRECT
ANSWER✅✅multidisciplinary model
Premium - CORRECT ANSWER✅✅amount of money that must be periodically paid to a health insurance
company in return for healthcare coverage
Guarantor - CORRECT ANSWER✅✅Person who is responsible for paying the bill for healthcare services
Revenue Cycle - CORRECT ANSWER✅✅the process of completing all the steps that the facility or
provider must take to ask for reimbursement from the payer and to ensure that the received payment is
correct
Reimbursement - CORRECT ANSWER✅✅The amount paid to a healthcare provider for services
provided to a patient.
Third party payer - CORRECT ANSWER✅✅Insurance company or health agency that pays the provider
for the care or services provided to the patient
Insurance - CORRECT ANSWER✅✅reduction of a person's exposure to risk of loss by having another
party assume the risk
Beneficiary - CORRECT ANSWER✅✅An individual who is eligible for benefits from a health plan
Risk pool - CORRECT ANSWER✅✅group of individuals or entities who have a similarly risk of loss
Policyholder - CORRECT ANSWER✅✅individual who purchases health insurance coverage
Dr. Gilbert sees a 17-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 third party in this healthcare reimbursement scenario - CORRECT ANSWER✅✅Insurance
Company
In this healthcare delivery model, the government is the only payer that funds universal healthcare
coverage through taxes: - CORRECT ANSWER✅✅National Health service model
Dr. Jones sees a 15-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 - CORRECT ANSWER✅✅Parents
In this healthcare delivery model, employees and employers contribute an income-based amount of
money to funds that are regulated by the government - CORRECT ANSWER✅✅Social Insurance Model
Which of the following is not a principle of revenue integrity? - CORRECT ANSWER✅✅No oversight
Which of the following is not a component of the revenue cycle? - CORRECT ANSWER✅✅Registration
calculation
In this delivery model, the insurance company determines the contribution amount that is not based on
the policyholder's income? - CORRECT ANSWER✅✅Private Health Insurance Model
A physician office submitting an invoice (claim) for payment when the patient has health insurance is an
example of a transaction between _____ & ______ - CORRECT ANSWER✅✅provider, third-party payer
Dr. March 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 second party in this healthcare reimbursement scenario - CORRECT ANSWER✅✅Dr. March
