HEALTHCARE REVENUE MANAGEMENT FINAL | FROM
QUESTION TO PERFECTION| STUDY WITH CONFIDENCE!
Course Code:
Course Title:
Programme:
Academic Year: 2026/2027.
Duration: 2 Hours.
Total Marks: 70%.
Candidate Instructions:
1) Write your Registration Number on every answer booklet used.
2) Answer ALL questions in Section A and ANY TWO (2) questions in Section B.
3) Read each question carefully before answering.
4) Begin each question on a new page.
5) The marks for each question are indicated in brackets.
6) This paper consists of several printed pages, including this page.
7) Ensure your copy is complete before the examination begins.
8) Unauthorized materials and communication with other candidates are not permitted.
Turn Over.
APPHIA – Crafted with Care and Precision for Academic Excellence.
1
, Abuse Answer: Unknowing or unintentional submission of an inaccurate claim for payment
Accountable Care Organization (ACO) Answer: population-based model for healthcare delivery
and payment
Accounts Receivable (AR) Answer: The amounts owed to a facility by patients or insurance
companies who receive services but whose payments will be made at a later date.
Actual Charge Answer: The amount a physician or supplier actually bills for a particular service
or supply.
Adjudication Answer: (1) The determination of the reimbursement amount based on the
beneficiary's insurance plan benefits. (2) The process by the payer of paying claims submitted or
denying them after comparing the claim to the benefit and coverage requirements.
Allowable charge Answer: amount the third-party payer or insurance company will pay for a
service
Ambulatory Payment Classification (APC) Answer: A resource-based system used in the
Medicare Hospital Outpatient Prospective Payment System (OPPS). The APC system combines
procedures and services that are clinically comparable, with respect to resource use, into groups
which are used to determine reimbursement levels.
Ambulatory surgery center (ASC) Answer: Under Medicare, an outpatient surgical facility that
has its own national identifier; is a separate entity with respect to its licensure, accreditation,
governance, professional supervision, administrative functions, clinical services, record keeping,
and financial and accounting systems; has as its sole purpose the provision of services in
connection with surgical procedures that do not require inpatient hospitalization; and meets the
conditions and requirements set forth in the Medicare Conditions of Participation
Appeal Answer: A request for a review of an insurance claim that has been underpaid or denied
by an insurance company in an effort to receive additional payment.
Assignment of benefits Answer: Contract between a physician and Medicare in which the
physician agrees to bill Medicare directly for covered services, to bill the beneficiary only for
any coinsurance or deductible that may be applicable and to accept the Medicare payment as a
payment in full. Medicare usually pays 80% of the approved amount directly to the provider of
services after the beneficiary meets the annual Part B deductible. The beneficiary pays the other
20% (coinsurance).
Barcoding Answer: Tagging the packaging of each item with a machine-readable Universal
Product Code (UPC) to identify a medication
Benchmarking Answer: The process of comparing performance with a preestablished standard
or performance of another facility or group.
Beneficiary Answer: An individual who is eligible for benefits from a health plan
APPHIA – Crafted with Care and Precision for Academic Excellence.
2
QUESTION TO PERFECTION| STUDY WITH CONFIDENCE!
Course Code:
Course Title:
Programme:
Academic Year: 2026/2027.
Duration: 2 Hours.
Total Marks: 70%.
Candidate Instructions:
1) Write your Registration Number on every answer booklet used.
2) Answer ALL questions in Section A and ANY TWO (2) questions in Section B.
3) Read each question carefully before answering.
4) Begin each question on a new page.
5) The marks for each question are indicated in brackets.
6) This paper consists of several printed pages, including this page.
7) Ensure your copy is complete before the examination begins.
8) Unauthorized materials and communication with other candidates are not permitted.
Turn Over.
APPHIA – Crafted with Care and Precision for Academic Excellence.
1
, Abuse Answer: Unknowing or unintentional submission of an inaccurate claim for payment
Accountable Care Organization (ACO) Answer: population-based model for healthcare delivery
and payment
Accounts Receivable (AR) Answer: The amounts owed to a facility by patients or insurance
companies who receive services but whose payments will be made at a later date.
Actual Charge Answer: The amount a physician or supplier actually bills for a particular service
or supply.
Adjudication Answer: (1) The determination of the reimbursement amount based on the
beneficiary's insurance plan benefits. (2) The process by the payer of paying claims submitted or
denying them after comparing the claim to the benefit and coverage requirements.
Allowable charge Answer: amount the third-party payer or insurance company will pay for a
service
Ambulatory Payment Classification (APC) Answer: A resource-based system used in the
Medicare Hospital Outpatient Prospective Payment System (OPPS). The APC system combines
procedures and services that are clinically comparable, with respect to resource use, into groups
which are used to determine reimbursement levels.
Ambulatory surgery center (ASC) Answer: Under Medicare, an outpatient surgical facility that
has its own national identifier; is a separate entity with respect to its licensure, accreditation,
governance, professional supervision, administrative functions, clinical services, record keeping,
and financial and accounting systems; has as its sole purpose the provision of services in
connection with surgical procedures that do not require inpatient hospitalization; and meets the
conditions and requirements set forth in the Medicare Conditions of Participation
Appeal Answer: A request for a review of an insurance claim that has been underpaid or denied
by an insurance company in an effort to receive additional payment.
Assignment of benefits Answer: Contract between a physician and Medicare in which the
physician agrees to bill Medicare directly for covered services, to bill the beneficiary only for
any coinsurance or deductible that may be applicable and to accept the Medicare payment as a
payment in full. Medicare usually pays 80% of the approved amount directly to the provider of
services after the beneficiary meets the annual Part B deductible. The beneficiary pays the other
20% (coinsurance).
Barcoding Answer: Tagging the packaging of each item with a machine-readable Universal
Product Code (UPC) to identify a medication
Benchmarking Answer: The process of comparing performance with a preestablished standard
or performance of another facility or group.
Beneficiary Answer: An individual who is eligible for benefits from a health plan
APPHIA – Crafted with Care and Precision for Academic Excellence.
2
