BHA4009
Health Care Reimbursement Systems
MIDTERM READINESS EXAM
GUIDE
Q&S
©2024/2025
,1. Which of the following models focuses on the payment
structure that incentivizes health care providers for quality
of care rather than quantity?
- A) Fee-for-Service
- B) Value-Based Care
- C) Capitation
- D) Pay-for-Performance
- Correct Answer: B) Value-Based Care
Rationale: Value-Based Care emphasizes outcomes
and quality, rewarding providers for delivering high-quality
services.
2. In which reimbursement model do providers receive a
set amount per enrolled patient, regardless of the number of
services provided?
- A) Fee-for-Service
- B) Capitation
- C) Global Budget
- D) Cost-Plus
- Correct Answer: B) Capitation
Rationale: Capitation is a payment arrangement where
providers are paid per patient, regardless of how many
services they provide.
3. What is the primary purpose of the Relative Value Unit
(RVU) system in health care reimbursement?
- A) To standardize patient outcomes
- B) To determine the cost of services
- C) To establish payment rates for health care providers
- D) To improve patient satisfaction
- Correct Answer: C) To establish payment rates for
©2024/2025
, health care providers
Rationale: RVUs help determine reimbursement rates
based on resource costs, time, and complexity involved in
providing a service.
4. Which of the following is a risk-sharing mechanism
commonly used in Accountable Care Organizations
(ACOs)?
- A) Bundled Payments
- B) Fee-for-Service
- C) Capitation
- D) Shared Savings
- Correct Answer: D) Shared Savings
Rationale: Shared Savings programs in ACOs allow
providers to share in cost savings achieved through
improved efficiency and quality.
5. Which federal program provides health coverage for
individuals with low income, primarily focusing on families
and children?
- A) Medicare
- B) Medicaid
- C) TRICARE
- D) CHIP
- Correct Answer: B) Medicaid
Rationale: Medicaid is designed to provide health care
coverage for low-income individuals and families.
### Fill-in-the-Blank Questions
6. The ________ Adjustment Factor is used to determine
reimbursement rates to account for geographic differences
in the cost of providing services.
©2024/2025
Health Care Reimbursement Systems
MIDTERM READINESS EXAM
GUIDE
Q&S
©2024/2025
,1. Which of the following models focuses on the payment
structure that incentivizes health care providers for quality
of care rather than quantity?
- A) Fee-for-Service
- B) Value-Based Care
- C) Capitation
- D) Pay-for-Performance
- Correct Answer: B) Value-Based Care
Rationale: Value-Based Care emphasizes outcomes
and quality, rewarding providers for delivering high-quality
services.
2. In which reimbursement model do providers receive a
set amount per enrolled patient, regardless of the number of
services provided?
- A) Fee-for-Service
- B) Capitation
- C) Global Budget
- D) Cost-Plus
- Correct Answer: B) Capitation
Rationale: Capitation is a payment arrangement where
providers are paid per patient, regardless of how many
services they provide.
3. What is the primary purpose of the Relative Value Unit
(RVU) system in health care reimbursement?
- A) To standardize patient outcomes
- B) To determine the cost of services
- C) To establish payment rates for health care providers
- D) To improve patient satisfaction
- Correct Answer: C) To establish payment rates for
©2024/2025
, health care providers
Rationale: RVUs help determine reimbursement rates
based on resource costs, time, and complexity involved in
providing a service.
4. Which of the following is a risk-sharing mechanism
commonly used in Accountable Care Organizations
(ACOs)?
- A) Bundled Payments
- B) Fee-for-Service
- C) Capitation
- D) Shared Savings
- Correct Answer: D) Shared Savings
Rationale: Shared Savings programs in ACOs allow
providers to share in cost savings achieved through
improved efficiency and quality.
5. Which federal program provides health coverage for
individuals with low income, primarily focusing on families
and children?
- A) Medicare
- B) Medicaid
- C) TRICARE
- D) CHIP
- Correct Answer: B) Medicaid
Rationale: Medicaid is designed to provide health care
coverage for low-income individuals and families.
### Fill-in-the-Blank Questions
6. The ________ Adjustment Factor is used to determine
reimbursement rates to account for geographic differences
in the cost of providing services.
©2024/2025
