PRINCIPALS OF HEALTHCARE
REIMBURSEMENT AND REVENUE CYCLE
MANAGEMENT COMPREHENSIVE
EXAMINATION TEST COMPLETE
QUESTIONS WITH ACCURATE SOLUTIONS
●● The notice from the healthcare insurance plan used the abbreviation
"PMPM." How should the insurance analyst interpret this abbreviation?
Answer: Per member per month
●● The ICD-10-CM/PCS Coordination and Maintenance Committee is
composed of representatives from __________ and __________
Answer: NCHS and CMS
●● In which type of reimbursement methodology do healthcare
insurance companies reimburse providers after the costs have been
incurred?
Answer: Retrospective payment
●● The health plan reimburses Dr. Tan $15 per patient per month. In
January, Dr. Tan was contracted with the health plan to serve 300
members, of which he provided services to 100. He received $4,500
from the health plan. What method is the health plan using to reimburse
Dr. Tan?
,Answer: Capitated rate
●● In which type of healthcare payment method does the healthcare plan
pay for each service that a provider renders?
Answer: Fee-for-service reimbursement
●● All of the following are discounted fee-for-service healthcare
payment methods except:
CRG
CPR 10
RBRVS
UCR
Answer: CRG
●● CPT Category III codes represent:
Answer: Emerging technologies
●● In which type of reimbursement methodology does the health
insurance company have the greatest degree of risk?
Answer: Retrospective
●● ____was created for reporting procedures and services performed by
physicians in clinical practice?
, Answer: CPT
●● The coding system that is used for reporting diagnoses for hospital
inpatients is known as __________.
Answer: ICD-10-CM
●● The Health Insurance Portability and Accountability Act (HIPPA)
was enacted in __________.
Answer: 1996
●● _________maintains the International Classification of Diseases
(ICD)
Answer: the World Health Organization (WHO)
●● HCPCS Level II codes begin with
Answer: an alpha character followed by four numbers (A1234)
●● The official publication for CPT® coding issues and guidance is
called the:
Answer: CPT Assistant by the AMA
●● In the IPPS, ____________ is the term for each hospital's unique
standardized amount based on its costs per Medicare discharge
REIMBURSEMENT AND REVENUE CYCLE
MANAGEMENT COMPREHENSIVE
EXAMINATION TEST COMPLETE
QUESTIONS WITH ACCURATE SOLUTIONS
●● The notice from the healthcare insurance plan used the abbreviation
"PMPM." How should the insurance analyst interpret this abbreviation?
Answer: Per member per month
●● The ICD-10-CM/PCS Coordination and Maintenance Committee is
composed of representatives from __________ and __________
Answer: NCHS and CMS
●● In which type of reimbursement methodology do healthcare
insurance companies reimburse providers after the costs have been
incurred?
Answer: Retrospective payment
●● The health plan reimburses Dr. Tan $15 per patient per month. In
January, Dr. Tan was contracted with the health plan to serve 300
members, of which he provided services to 100. He received $4,500
from the health plan. What method is the health plan using to reimburse
Dr. Tan?
,Answer: Capitated rate
●● In which type of healthcare payment method does the healthcare plan
pay for each service that a provider renders?
Answer: Fee-for-service reimbursement
●● All of the following are discounted fee-for-service healthcare
payment methods except:
CRG
CPR 10
RBRVS
UCR
Answer: CRG
●● CPT Category III codes represent:
Answer: Emerging technologies
●● In which type of reimbursement methodology does the health
insurance company have the greatest degree of risk?
Answer: Retrospective
●● ____was created for reporting procedures and services performed by
physicians in clinical practice?
, Answer: CPT
●● The coding system that is used for reporting diagnoses for hospital
inpatients is known as __________.
Answer: ICD-10-CM
●● The Health Insurance Portability and Accountability Act (HIPPA)
was enacted in __________.
Answer: 1996
●● _________maintains the International Classification of Diseases
(ICD)
Answer: the World Health Organization (WHO)
●● HCPCS Level II codes begin with
Answer: an alpha character followed by four numbers (A1234)
●● The official publication for CPT® coding issues and guidance is
called the:
Answer: CPT Assistant by the AMA
●● In the IPPS, ____________ is the term for each hospital's unique
standardized amount based on its costs per Medicare discharge
