Healthcare Finance Midterm Question
and answers already 2025/2026
Employee-covered health plans are most likely to be - correct answer ✔PPO
Explain what HIPAA is - correct answer ✔is a federal law that required the creation of national
standards to protect sensitive patient health information from being disclosed without the patient's
consent or knowledge
What are the 3 major registration activities - correct answer ✔Insurance verification, Copayment or
deductible collection, Financial counseling
What are the 3 sources of funding for a healthcare organization (HCO) - correct answer ✔Gifts, capital,
and revenues
T/F: Medicare uses resource utilization groups as a basis for reimbursement to Home Health Agencies. -
correct answer ✔False
Definition of Capitation Rates: - correct answer ✔An agreed-upon amount by contract with insurance
and providers. Insurance will pay a negotiated rate to providers if providers agree to see a specific
number of patients under a defined time period.
Which part of Medicare services covers Hospice Care: - correct answer ✔Medicare Part A
The International Classification of Diseases (ICD): is used to report inpatient or outpatient visits. - correct
answer ✔Inpatient
T/F: Claims editing is initiated once the claim is submitted to the payer for payment. - correct answer
✔False
, How do HCOs use funds: - correct answer ✔Investment, Capital (big projects), Expenses (employee
benefits, employee bonuses, etc)
Revenue generation is impacted by 3 areas: - correct answer ✔Pricing, contract negotiation, coding/
billing
Which of the following can a health provider vary across different payers:Charges, Discounts, quality of
care, access to emergency services - correct answer ✔Discounts
T/F: The actual charges for services provided for the cost are not relevant once a DRG assignment has
been made. - correct answer ✔True
T/F: Claims editing is initiated once the claim has been submitted. - correct answer ✔False
T/F: Data in the medical record is the primary source for documenting the provision of services. - correct
answer ✔True
ICD-10 codes are used to report which of the following: Surgical procedures, Hospital Inpatient
Procedures, Hospital outpatient procedures - correct answer ✔Hospital Inpatient Procedures
In most healthcare organizations, the largest percentage of payment comes from one of the following?
Self payers, Third-party payers, Grants, Tax support - correct answer ✔Third-party payers
Which of the following segments receives little or no funding from private insurance? Hospitals,
Physicians, Prescription drugs, Nursing homes - correct answer ✔Nursing Homes
and answers already 2025/2026
Employee-covered health plans are most likely to be - correct answer ✔PPO
Explain what HIPAA is - correct answer ✔is a federal law that required the creation of national
standards to protect sensitive patient health information from being disclosed without the patient's
consent or knowledge
What are the 3 major registration activities - correct answer ✔Insurance verification, Copayment or
deductible collection, Financial counseling
What are the 3 sources of funding for a healthcare organization (HCO) - correct answer ✔Gifts, capital,
and revenues
T/F: Medicare uses resource utilization groups as a basis for reimbursement to Home Health Agencies. -
correct answer ✔False
Definition of Capitation Rates: - correct answer ✔An agreed-upon amount by contract with insurance
and providers. Insurance will pay a negotiated rate to providers if providers agree to see a specific
number of patients under a defined time period.
Which part of Medicare services covers Hospice Care: - correct answer ✔Medicare Part A
The International Classification of Diseases (ICD): is used to report inpatient or outpatient visits. - correct
answer ✔Inpatient
T/F: Claims editing is initiated once the claim is submitted to the payer for payment. - correct answer
✔False
, How do HCOs use funds: - correct answer ✔Investment, Capital (big projects), Expenses (employee
benefits, employee bonuses, etc)
Revenue generation is impacted by 3 areas: - correct answer ✔Pricing, contract negotiation, coding/
billing
Which of the following can a health provider vary across different payers:Charges, Discounts, quality of
care, access to emergency services - correct answer ✔Discounts
T/F: The actual charges for services provided for the cost are not relevant once a DRG assignment has
been made. - correct answer ✔True
T/F: Claims editing is initiated once the claim has been submitted. - correct answer ✔False
T/F: Data in the medical record is the primary source for documenting the provision of services. - correct
answer ✔True
ICD-10 codes are used to report which of the following: Surgical procedures, Hospital Inpatient
Procedures, Hospital outpatient procedures - correct answer ✔Hospital Inpatient Procedures
In most healthcare organizations, the largest percentage of payment comes from one of the following?
Self payers, Third-party payers, Grants, Tax support - correct answer ✔Third-party payers
Which of the following segments receives little or no funding from private insurance? Hospitals,
Physicians, Prescription drugs, Nursing homes - correct answer ✔Nursing Homes
