HIT 206 FINAL REVIEW QUESTIONS WITH CORRECT ANSWERS LATEST UPDATE 2026

HIT 206 FINAL REVIEW QUESTIONS WITH CORRECT ANSWERS LATEST UPDATE 2026 what are the reasons for the rising cost in healthcare - Answers the aging population requires more healthcare services what are accounts receivable (AR) - Answers monies owed to a medical practice what are accounts payable (AP) - Answers a practice's operating expenses what is a revenue cycle management (RCM) - Answers process of making sure sufficient monies flow into the practice to pay the practice's bills what is a practice management program (PMP) - Answers account software used for scheduling appointments, billing, and financial record keeping what is an electronic health record (EHR) - Answers computerized lifelong healthcare record for an individual that incorporates data from all sources what is a policyholder - Answers a person who buys an insurance plan what is a policyholder also known as - Answers the insured, the member, or the subscriber what are benefits - Answers payments from medical services fora a specific period what are health plans also referred to as - Answers payers what are the 3 parties of payers - Answers first-party- patients second party- physician third party- insurance company what is a schedule of benefits - Answers list of medical expenses covered by a health plan what is a medically necessary service - Answers a service that is reasonable and is consistent with generally accepted medical standards for the diagnosis treatment of illness or injury what is a preventative medical service - Answers care provided to keep patients health or prevent illness what are examples of preventative medical services - Answers physical exams, immunizations, prenatal care and routine screening procedures such as mammograms what constitutes as a provider - Answers physicians, nurse practitioners, physician assistants, therapist, hospitals, laboratories, long term care facilities, and suppliers such as pharmacies and medical supply companies whats considered covered services - Answers primary care, emergency care, medical specialists services, and surgery whats considered non-covered services - Answers medical procedures that are not included in a plan such as dental services, eye exams, or glasses, employment related injuries, cosmetic procedures, or experimental/investigation procedures what are deductibles - Answers amount that insured must pay for healthcare services before a health plans payment begins what are co-payments - Answers amount a beneficiary must pay at the time of a healthcare encounter what is coinsurance - Answers portion of charges an insured person must pay for healthcare services after the deducible what does out of pocket max mean - Answers the most an individual will pay within a given year what is applied to the out of pocket max - Answers deductibles, co-payments, and coinsurance whats fee for service mean - Answers its a retroactive payment method in which the fee is paid after the patient receives services from the physician what type of plan usually reimburses on a fee for service basis - Answers indemnity plans what is an indemnity plan - Answers health plan that offers protection from loss under medicare fee for service plan, how is the plan operated - Answers the plan is operated by a private insurance company that contracts with medicare but pays on a fee for service basis who can medicaid patients on a fee for service plan receive treatment from - Answers the provider of their choosing if that provider accepts medicaid how does a medicaid provider submit a fee for service claim - Answers the provider submits the claim to medicaid and is paid directly by medicaid what format are health care claims sent in - Answers paper or electronic if you have an HMO plan what would have to take place before an MRI can take place - Answers preauthorization what is capitation - Answers a fixed prepayment covering providers services for a plan member for a specified period what is a health maintenance organization (HMO) plan - Answers managed health care system in which providers offer healthcare to members for fixed periodic payments its a plan that only allows the patient to see specific physicians within their network what do HMO plans require - Answers restricted choice of providers preauthorization for services co-payments gatekeeper or also known as a PCP what does the provider risk with capitation in HMOs - Answers since the payment per patient remains the same, the provider risks receiving lower per-visit revenue what is the capitated rate called - Answers per member per month (PMPM) what is the per member per month (PMPM) based on - Answers the health-related characteristics of the enrollees, such as age and gender what is a point of service plan - Answers an open HMO which reduces restrictions and allows members to choose providers who are not in the HMO network what are the benefits of a preferred provider organization (PPO) - Answers doesn't require a PCP referrals to specialists are not required high premium and copayment members can choose from many in-network generalists and specialists members can use out of network providers for higher copayments, increased deductible or both what is a consumer driven plan - Answers medical insurance that combines a high-deductible health plan with a medical savings plan what are the steps in the medical billing cycle - Answers preregister patients establish financial responsibility check in patients review coding compliance review billing compliance check out patients prepare and transmit claims monitor payer adjudication generate patient statements follow up payments and collections what is a patient ledger - Answers record of patients financial transactions what is adjudication - Answers when the payer puts the claim through a series of steps designed to judge whether it should be paid what the payer decides about t. he claim to pay it in full, to pay some of it, to pend it for further information to arrive, or to deny it which is explained on the RA what is malpractice - Answers failure to use professional skill when giving medical services that results in injury or harm what is an encounter - Answers visit between a patient and a medical professional what does SOAP mean - Answers subjective, objective, assessment, plan what does subjective mean - Answers what the patient says is going on what does objective mean - Answers examination and/or test results what does assessment mean - Answers assessment of the patients diagnosis what does plan mean - Answers the intended cause of treatment, such as surgery or medication what does E/M stand for - Answers evaluation and management what does EHR stand for - Answers electronic health record what does CMS stand for - Answers centers for Medicare and Medicaid services what does HIPAA stand for - Answers Health Insurance Portability and Accountability Act what is a clearing house - Answers company that help providers handle electronic transactions as submitting claims and that manage electronic medical record systems what are EDI exchanges - Answers electronic data interchange system to system exchange of data in a standardized format what are ACOs - Answers accountable care organizations network that shares responsibility for managing the quality and cost of care provided to a group of patients what is a covered entity - Answers health plan, clearing house, or provider who transmits any health information in electronic format what is a business associate - Answers person or organization that performs a function or activity for a covered entity what is ARRA - Answers american recovery reinvestment act law with provisions concerning the standards for the electronic transmissions of healthcare data what is HITECH - Answers health information technology for economic and clinical health act law promoting the adoption and use of health information technology what is HIE - Answers health Information exchange enables the sharing of health related information amount provider organizations what must a covered entity give each patient at the first contact or encounter - Answers notice of privacy practices assignment of benefits what is accounting of disclosure - Answers documentation of the disclosure of a patients PHI in that persons medical record in unauthorized cases what is a breach - Answers impermissible use or disclosure of PHI that could pose significant risk to the affected person what should you do if there is a breach - Answers send a breach notification to patients within 60 days covered entities media outlets next of kin if patient was deceased secretary of HHS what is fraud - Answers intentional deceptive act to obtain a benefit what is abuse - Answers action that improperly uses another's resources what is PHI - Answers protected health information individually identifiable health information transmitted or maintained by electronic media whats included in PHI - Answers any type of personal information transmitted or maintained by electronic media what is TCS - Answers HIPAA electronic health care transactions and code sets standards that make it possible for physicians and health plans to exchange electronic data using a standard format and standard code set what is X12 837 - Answers transaction sent to a secondary or tertiary payer / coordination of benefits what is 837P - Answers 837:Professional COB claim form that physician offices use what is 837I - Answers COB claim form that hospitals use what is x12 276/277 - Answers healthcare claim status inquiry/response what is x12 270/271 - Answers eligibility for health plan inquiry/response what is x12 278 - Answers referral certification and authorization what is x12 835 - Answers healthcare payment and remittance advice what is x12 820 - Answers health plan premium payments what is x12 834 - Answers health plan enrollment and disenrollment what is TPO - Answers treatment payment and healthcare operations legitimate reasons for the sharing of patients protected health information without authorization in what cases, would providers not need specific authorization to release patients PHI - Answers discussing the patients case with other providers, submitting claims on behalf of patients, staff training and quality whats a direct provider - Answers clinician who treats a patient face-to-face whats an indirect provider - Answers clinician who does not treat a patient face to face what is an ABN and what is it used for - Answers advance beneficiary notice to show that the services received may or may not be paid by Medicare what is tertiary insruance - Answers third payer on a claim what is COB - Answers coordination of benefits explains how an insurance policy will pay when there is more than one payer what is the birthday rule - Answers guideline that determines which parent has the primary insurance for a child by a rule that states the parent whose birthday comes first in the year what is the gender rule - Answers if a child is covered by 2 health plans, the fathers plan is primary what is the parent rule providing the parents do not have joint custody - Answers the plan of the custodial parent the plan of the spouse of the custodial parent the plan of the parent without custody if parents have joint custody, what COB rule usually applies - Answers the birthday rule practices routinely collect what charges at the time of service - Answers previous balances copayments coinsurance noncovered or over limit fees charges of nonparticipating providers charges for self-pay patients deductibles charges for supplies and copies of medial records True or False, when a patient receives more than one covered service in a single day, the health plan may permit multiple copayments. For example copay's both for an annual physical exam and for lab test may be due from the patient - Answers true who is the insured - Answers the policyholder or subscriber to a health plan or policy who is the guarantor - Answers person who is financially responsible for the bill what does accepting assignment mean - Answers participating physicians agreement to accept allowed charge as full payment what does a nonPAR mean - Answers provider who does not join a particular health plan what does nonPAR not accepting assignment mean - Answers physicians that do not accept assignment and require full payment from patients at the time of service do nonPARs file claims on patients behalf - Answers no when is there an exception for nonPAR providers to bill claims on behalf of patients - Answers with medicare, which requires all providers to file claims for patients as a courtsey what is RTCA - Answers real time claim adjudication process used to generate the amount owed by a patient what does ICD stand for - Answers international classification of disease what is the alphabetic index - Answers part of ICD-10-CM listing diseases and injuries alphabetically with corresponding diagnosis codes