REVENUE CYCLE MANAGEMENT
MIDTERM EXAM QUESTIONS AND
ANSWERS (GRADED A+)
Who is the third party payer in healthcare situations?
a. patient
b. provider
c. payer - ANSWER-c. payer
Insurance companies pool premium payment for all the insureds in a group, then use
actuarial data to calculate the group's premiums so that which of the following occur?
a. premium payments are lowered for insurance plan payers
b. the pool is large enough to pay losses of the entire group
c. accounting for the group's plan is simplified - ANSWER-b. the pool is large enough to
pay losses of the entire group
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?
a. revenue integrity
b. revenue cycle
c. integrated revenue cycle - ANSWER-b. revenue cycle
What combines the revenue cycle for different types of services into one process. This
becomes complicated when there are multiple payment systems involved. But there are
benefits to the implementation of this concept including reducing cost, making
procedures consistent and focusing on strategic goals that benefit the organization?
a. revenue integrity
b. revenue cycle
c. integrated revenue cycle - ANSWER-c. integrated revenue cycle
What is completing one's assigned tasks by following the provided procedure and
following all rules?
a. revenue integrity
b. revenue cycle
c. integrated revenue cycle - ANSWER-a. revenue integrity
In this healthcare delivery model, the government is the only payer that funds universal
healthcare coverage through taxes:
a. social insurance model
b. cash model
c. national health service model
d. private health insurance model - ANSWER-c. national health service model
,In this healthcare delivery model, the insurance company determines that contribution
amount that is not based on the policyholder's income:
a. cash model
b. private health insurance model
c. social insurance model
d. national health service model - ANSWER-b. private health insurance model
What TRICARE health plan is a managed care for ADSMs and ADFMS?
a. TRICARE for Life
b. TRICARE Prime
c. TRICARE Select
d. TRICARE Young Adult - ANSWER-b. TRICARE Prime
What TRICARE health plan is a secondary payer for Medicare Part A and B eligible
beneficiaries?
a. TRICARE for Life
b. TRICARE Prime
c. TRICARE Select
d. TRICARE Young Adult - ANSWER-a. TRICARE for Life
In the healthcare sector, what is the term for a group of individual entities, such as
individual persons, employers, or associations, whose healthcare costs are combined
for evaluating financial history and estimating future costs?
a. in-network
b. wrap-around
c. limitation
d. risk pool - ANSWER-d. risk pool
The worker had group healthcare insurance coverage through her employer. The
worker's household included her spouse, two natural children (ages 28 and 12), an
adopted child (age 8), a 6-month infant in the waiting period prior to adoption, and the
worker's mother (age 58). Who may be included under dependent coverage in the
healthcare insurance policy?
a. spouse and natural child age 28
b. everyone in the household
c. spouse; two natural children, ages 28 and 12; and adopted child, age 8
d. spouse; natural child, age 12; and adopted child, age 8 - ANSWER-d. spouse; natural
child, age 12; and adopted child, age 8
In this healthcare delivery model, employees and employers contribute an income-
based amount of money to funds that are regulated by the government:
a. national health insurance model
b. private health insurance model
c. social insurance model
, d. cash model - ANSWER-c. social insurance model
The US healthcare sector represents a significant portion of the US economy. The trend
of ____ spending on healthcare has been consistent for more than a decade.
a. decreased
b. increased
c. steady - ANSWER-b. increased
An employee paying for 40 percent of the insurance premium through payroll
processing is an example of a transaction between ____ and ____
a. patient, provider
b. employer, third-party payer
c. payer, third-party payer
d. patient, employer - ANSWER-d. patient, employer
A physician office submitting an invoice for payment when the patient has health
insurance is an example of a transaction between ____ and ____.
a. provider, third-party payer
b. employer, third-party payer
c. patient, employer
d. patient, third-party payer - ANSWER-a. provider, third-party payer
Dr. Gilbert sees a 14-old-male with adolescent idiopathic thoracic scoliosis. Surgery for
spinal fusion was canceled 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 healthcare
insurance through the mother's employment at the State Department of Treasury.
Who is the first party in this healthcare reimbursement scenario? - ANSWER-parents
Dr. Gilbert sees a 14-old-male with adolescent idiopathic thoracic scoliosis. Surgery for
spinal fusion was canceled 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 healthcare
insurance through the mother's employment at the State Department of Treasury.
Who is the second party in this healthcare reimbursement scenario? - ANSWER-Dr.
Gilbert
Dr. Gilbert sees a 14-old-male with adolescent idiopathic thoracic scoliosis. Surgery for
spinal fusion was canceled 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 healthcare
insurance through the mother's employment at the State Department of Treasury.
MIDTERM EXAM QUESTIONS AND
ANSWERS (GRADED A+)
Who is the third party payer in healthcare situations?
a. patient
b. provider
c. payer - ANSWER-c. payer
Insurance companies pool premium payment for all the insureds in a group, then use
actuarial data to calculate the group's premiums so that which of the following occur?
a. premium payments are lowered for insurance plan payers
b. the pool is large enough to pay losses of the entire group
c. accounting for the group's plan is simplified - ANSWER-b. the pool is large enough to
pay losses of the entire group
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?
a. revenue integrity
b. revenue cycle
c. integrated revenue cycle - ANSWER-b. revenue cycle
What combines the revenue cycle for different types of services into one process. This
becomes complicated when there are multiple payment systems involved. But there are
benefits to the implementation of this concept including reducing cost, making
procedures consistent and focusing on strategic goals that benefit the organization?
a. revenue integrity
b. revenue cycle
c. integrated revenue cycle - ANSWER-c. integrated revenue cycle
What is completing one's assigned tasks by following the provided procedure and
following all rules?
a. revenue integrity
b. revenue cycle
c. integrated revenue cycle - ANSWER-a. revenue integrity
In this healthcare delivery model, the government is the only payer that funds universal
healthcare coverage through taxes:
a. social insurance model
b. cash model
c. national health service model
d. private health insurance model - ANSWER-c. national health service model
,In this healthcare delivery model, the insurance company determines that contribution
amount that is not based on the policyholder's income:
a. cash model
b. private health insurance model
c. social insurance model
d. national health service model - ANSWER-b. private health insurance model
What TRICARE health plan is a managed care for ADSMs and ADFMS?
a. TRICARE for Life
b. TRICARE Prime
c. TRICARE Select
d. TRICARE Young Adult - ANSWER-b. TRICARE Prime
What TRICARE health plan is a secondary payer for Medicare Part A and B eligible
beneficiaries?
a. TRICARE for Life
b. TRICARE Prime
c. TRICARE Select
d. TRICARE Young Adult - ANSWER-a. TRICARE for Life
In the healthcare sector, what is the term for a group of individual entities, such as
individual persons, employers, or associations, whose healthcare costs are combined
for evaluating financial history and estimating future costs?
a. in-network
b. wrap-around
c. limitation
d. risk pool - ANSWER-d. risk pool
The worker had group healthcare insurance coverage through her employer. The
worker's household included her spouse, two natural children (ages 28 and 12), an
adopted child (age 8), a 6-month infant in the waiting period prior to adoption, and the
worker's mother (age 58). Who may be included under dependent coverage in the
healthcare insurance policy?
a. spouse and natural child age 28
b. everyone in the household
c. spouse; two natural children, ages 28 and 12; and adopted child, age 8
d. spouse; natural child, age 12; and adopted child, age 8 - ANSWER-d. spouse; natural
child, age 12; and adopted child, age 8
In this healthcare delivery model, employees and employers contribute an income-
based amount of money to funds that are regulated by the government:
a. national health insurance model
b. private health insurance model
c. social insurance model
, d. cash model - ANSWER-c. social insurance model
The US healthcare sector represents a significant portion of the US economy. The trend
of ____ spending on healthcare has been consistent for more than a decade.
a. decreased
b. increased
c. steady - ANSWER-b. increased
An employee paying for 40 percent of the insurance premium through payroll
processing is an example of a transaction between ____ and ____
a. patient, provider
b. employer, third-party payer
c. payer, third-party payer
d. patient, employer - ANSWER-d. patient, employer
A physician office submitting an invoice for payment when the patient has health
insurance is an example of a transaction between ____ and ____.
a. provider, third-party payer
b. employer, third-party payer
c. patient, employer
d. patient, third-party payer - ANSWER-a. provider, third-party payer
Dr. Gilbert sees a 14-old-male with adolescent idiopathic thoracic scoliosis. Surgery for
spinal fusion was canceled 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 healthcare
insurance through the mother's employment at the State Department of Treasury.
Who is the first party in this healthcare reimbursement scenario? - ANSWER-parents
Dr. Gilbert sees a 14-old-male with adolescent idiopathic thoracic scoliosis. Surgery for
spinal fusion was canceled 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 healthcare
insurance through the mother's employment at the State Department of Treasury.
Who is the second party in this healthcare reimbursement scenario? - ANSWER-Dr.
Gilbert
Dr. Gilbert sees a 14-old-male with adolescent idiopathic thoracic scoliosis. Surgery for
spinal fusion was canceled 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 healthcare
insurance through the mother's employment at the State Department of Treasury.
