HIMA240 (HIMA 240) Quiz 1 | questions and answers latest spring 2026 | 100% scored - American Military University.

HIMA240 (HIMA 240) Quiz 1 Question 1 Which of the following entities is typically known as an employer-based health insurance plan (also called a “group plan”)? Question options: Private individual healthcare insurance plan Blue Cross and Blue Shield Employer-based healthcare insurance plan Medicare Question 2 Which payer is primarily responsible for setting federal standards and influencing payment methods for Medicare and Medicaid in the U.S.? Question options: Centers for Medicare & Medicaid Services (CMS) State of California Medicare Payment Advisory Commission Private insurance companies Question 3 A health insurance policy includes a clause: once the insured spends $2,000 in coinsurance during a benefit year, the insurance pays all covered services for the rest of that year with no further coinsurance. This type of clause is known as a: Question options: Stop-loss benefit Out-of-Pocket Maximum Premium Balance Catastrophic Expense Limit Question 4 Which coding system is used for reporting diagnoses in both inpatient and outpatient settings in the U.S., and is required for Medicare and Medicaid billing?Question options: ICD-10-CM HCPCS Level II CPT ICD-10-PCS Question 5 What is the industry term for the document submitted by a provider to an insurance payer to request payment for services rendered? Question options: Allowance Charge Claim Explanation of Benefits Question 6 Which of the following is not a characteristic of commercial (private) health insurance? Question options: Coverage often negotiated between employer groups and insurance carriers Plans often have deductibles, copayments, coinsurance amounts Costs typically regulated by federal law exactly as Medicare/Medicaid are Private insurance premiums paid partly (or wholly) by individuals or employers Question 7 What term best describes the cost-sharing amount a patient pays each time they receive a service, such as seeing a specialist? Question options: Deductible Coinsurance CopaymentOut-of-Pocket Maximum Question 8 Which payment method involves a fixed, pre-negotiated amount per patient per month paid to a provider, regardless of how many services the patient uses? Question options: Prospective Payment Capitation Fee-for-Service Global Payment Question 9 Which of the following best describes the primary purpose of health insurance? Question options: To reduce patient exposure to high healthcare costs by transferring risk to an insurance entity To eliminate the need for healthcare payments entirely To ensure all healthcare providers receive the same payment rates To prevent healthcare fraud in all cases Question 10 Which U.S. program primarily provides healthcare coverage for individuals aged 65 and older? Question options: Medicaid Medicare TRICARE CHIP Question 11 In managed care, which model requires members to select a primary care provider (PCP) for referrals?Question options: PPO HMO EPO FFS Question 12 What does the abbreviation CMS stand for in healthcare reimbursement? Question options: Centers for Medicare & Medicaid Services Central Medical Standards Centers for Medical Services Clinical Medicare Systems Question 13 Which entity oversees Medicare and Medicaid programs in the U.S.? Question options: CDC CMS FDA OIG Question 14 Scenario: A patient pays $30 at each doctor's visit before services are provided. What is this payment called? Question options: Deductible Coinsurance CopaymentPremium Question 15 Which of the following represents a bundled payment system? Question options: Monthly payments per patient regardless of services Payment for each service rendered Payment based on per-day rates One payment for all services during a single episode of care Question 16 Scenario: A facility uses software to check claims for coding errors before submission. This process is called: Question options: Claim adjudication Claim scrubbing Denial management Charge capture Question 17 The Affordable Care Act eliminated all copayments and deductibles in U.S. healthcare plans. Question options: True False Question 18 A Health Maintenance Organization (HMO) allows patients to see any provider without a referral. Question options: True False Question 19Medicare Part A primarily covers: Question options: Prescription drugs Hospital inpatient services Physician office visits Dental and vision care Question 20 The main advantage of managed care plans for patients is: Question options: Unlimited provider choice without cost Coordinated care at reduced costs No requirement for prior authorizations Exclusion of preventive services