HI 225
Foundations of Classification,
Compliance, & Reimbursement
Methodologies
FINAL READINESS GUIDE
Q&S
©2024/2025
,1. What is the primary purpose of the ICD coding system?
- A) To ensure hospital profitability
- B) To improve patient care
- C) To create standardized data for health management
and billing
- D) To facilitate surgical interventions
- Correct Answer: C
- Rationale: The ICD (International Classification of
Diseases) coding system standardizes data for morbidity
and mortality statistics, billing, and health management.
2. Which of the following reimbursement methodologies is
based on diagnosis-related groups (DRGs)?
- A) Fee-for-service
- B) Capitation
- C) Bundled payments
- D) Prospective payment system
- Correct Answer: D
- Rationale: The Prospective Payment System (PPS)
uses DRGs to determine payment amounts based on
patient diagnoses.
3. During an audit, a discrepancy is identified between the
medical records and the coded data submitted for
reimbursement. What is the most appropriate action?
- A) Ignore the discrepancy
- B) Revise the coding to match the reimbursement claim
- C) Investigate the discrepancy further to ensure
compliance
- D) Inform the patient immediately
- Correct Answer: C
©2024/2025
, - Rationale: Investigating discrepancies is crucial for
compliance, accuracy, and quality improvement in health
information management.
4. Which of the following is a key component of Health
Information Exchange (HIE)?
- A) Manual patient record retrieval
- B) Fragmented data storage
- C) Interoperability between systems
- D) Limited access to patient data
- Correct Answer: C
- Rationale: Interoperability is essential for HIE to allow
healthcare providers to share and access patient
information seamlessly.
5. In the context of healthcare reimbursement, what does
the term "outlier" refer to?
- A) A patient who does not follow discharge instructions
- B) A service that falls outside the normal range of costs
- C) A rare disease not typically seen in the population
- D) A health provider with low patient volumes
- Correct Answer: B
- Rationale: An outlier is a case that significantly
deviates from the standard expected cost, warranting
special payment provisions.
### Fill-in-the-Blank Questions
6. The __________ is a set of codes used to describe
healthcare services, procedures, and the supplies provided
to patients.
- Correct Answer: CPT (Current Procedural
Terminology)
©2024/2025
Foundations of Classification,
Compliance, & Reimbursement
Methodologies
FINAL READINESS GUIDE
Q&S
©2024/2025
,1. What is the primary purpose of the ICD coding system?
- A) To ensure hospital profitability
- B) To improve patient care
- C) To create standardized data for health management
and billing
- D) To facilitate surgical interventions
- Correct Answer: C
- Rationale: The ICD (International Classification of
Diseases) coding system standardizes data for morbidity
and mortality statistics, billing, and health management.
2. Which of the following reimbursement methodologies is
based on diagnosis-related groups (DRGs)?
- A) Fee-for-service
- B) Capitation
- C) Bundled payments
- D) Prospective payment system
- Correct Answer: D
- Rationale: The Prospective Payment System (PPS)
uses DRGs to determine payment amounts based on
patient diagnoses.
3. During an audit, a discrepancy is identified between the
medical records and the coded data submitted for
reimbursement. What is the most appropriate action?
- A) Ignore the discrepancy
- B) Revise the coding to match the reimbursement claim
- C) Investigate the discrepancy further to ensure
compliance
- D) Inform the patient immediately
- Correct Answer: C
©2024/2025
, - Rationale: Investigating discrepancies is crucial for
compliance, accuracy, and quality improvement in health
information management.
4. Which of the following is a key component of Health
Information Exchange (HIE)?
- A) Manual patient record retrieval
- B) Fragmented data storage
- C) Interoperability between systems
- D) Limited access to patient data
- Correct Answer: C
- Rationale: Interoperability is essential for HIE to allow
healthcare providers to share and access patient
information seamlessly.
5. In the context of healthcare reimbursement, what does
the term "outlier" refer to?
- A) A patient who does not follow discharge instructions
- B) A service that falls outside the normal range of costs
- C) A rare disease not typically seen in the population
- D) A health provider with low patient volumes
- Correct Answer: B
- Rationale: An outlier is a case that significantly
deviates from the standard expected cost, warranting
special payment provisions.
### Fill-in-the-Blank Questions
6. The __________ is a set of codes used to describe
healthcare services, procedures, and the supplies provided
to patients.
- Correct Answer: CPT (Current Procedural
Terminology)
©2024/2025
