NEBC EXAM 2025/2026 QUESTIONS AND
ANSWERS 100% PASS
For Profit Organizations - ANS Can lawfully release a patient who does not have the ability to
pay for services (after EMTALA). Serve lower income populations. Owned by investors or
shareholders. Large portion of budget allocated to marketing and advertising.
not-for-profit organizations - ANS Must treat all conditions or people regardless of insurance
or ability to pay. Considered charities by IRS. Do not pay federal or state/local property taxes.
Obligation to the community.
Medicare - ANS National Health Insurance program for people 65 and older, disabled, and
any age with ESRD.
Medicare A - ANS Covers inpatient hospital stays, some hospice and home health care, no
monthly premium
Medicare B - ANS Medical insurance, pays for doctor services and outpatient services, PT/OT
services. Monthly premium.
Medicare C - ANS Often called the advantage plan or choice plan. Includes A and B, most
include D. May offer dental, vision, and wellness
Medicare D - ANS Prescription drug coverage. Monthly premium. Available to everyone,
must join Medicare plan that includes part D
pg. 1 @COPYRIGHT 2025/2026 ALLRIGHTS RESERVED
,Medicaid - ANS A federal and state assistance program that pays for health care services for
people who cannot afford them. Low-income children, pregnant women, and elderly. Pays long
term care.
Affordable Care Act - ANS An expansion of medicaid, most of employers must provide health
insurance, have insurance or face surtax, prevents rejection based on pre-existing condition.
Also referred to as "Obamacare", signed into law in 2010. Make affordable health insurance
available to more people.
Payors - ANS Employers, government, insurance companies, people who pay for healthcare
services
Charity Pay - ANS Healthcare system received no reimbursement for services
Health Maintenance Organization (HMO) - ANS an organization that provides comprehensive
medical care to subscribers for a fixed fee. Cost effective care focused on preventative care.
Network, group, staff and independent practice associations.
Preferred Provider Organization (PPO) - ANS Group of healthcare providers that provide
services to a specific group, often at a reduced rate. Cost is higher to use out of network
provider. Help negotiate cost of services between the providers and purchasers.
Diagnosis Related Group (DRGs) - ANS classifies patients by age, diagnosis, surgical
procedure, and other information with hundreds of different categories to predict the use of
hospital resources, including length of stay, resulting in a fixed payment amount
Prospective Payment Systems (PPS) - ANS Required facilities providing services to Medicare
clients to be reimbursed using a fixed-rate system and included monetary incentives to reduce
the length of hospital stays.
pg. 2 @COPYRIGHT 2025/2026 ALLRIGHTS RESERVED
, (Based on diagnosis-related group (DRG) categories)
Social Health Maintenance Organization (SHMO) - ANS special type of health plan that
provides the full range of Medicare benefits offered by standard Medicare HMOs, plus other
services that include the following: prescription drug and chronic care benefits, respite care,
and short-term nursing home care; homemaker, personal care services, and medical
transportation; eyeglasses, hearing aids, and dental benefits
Pay for Performance (P4P) - ANS performance-oriented incentives for hospitals and
physicians to improve the quality of patient healthcare. 4 quality measures - performance,
outcomes, patient satisfaction/experience, structures and technologies (EHR)
Value Based Purchasing - ANS A pay for performance methodology used to reimburse
hospitals based on outcomes. Provided by Centers for Medicare and Medicaid Services.
Incentive payments to acute-care hospitals yearly based on total performance score (TPS)
Budget Cycle - ANS Includes development, monitoring, reporting, justifying and variance
analysis. Four types of budget - revenue, expense, capital, and operating
Revenue - ANS anticipated amount of income during the budget period
Expense - ANS salary and nonsalary, fixed costs (remain constant such as rental fees and
contract fees) and variable costs (fluctuate based on unit activity such as census and acuity)
Capital - ANS equipment and renovation expenses. lifespan of 1 year of greater. consider
cost of item, installation, shipping or delivery charges, service contracts. Amortization (assigning
cost of asset over its lifetime) Depreciation (expensing fixed assets annually)
Operating Budget - ANS Annual budget. Based on past years unit activity predicting for next
year. Revenues and expenses for fiscal year.
pg. 3 @COPYRIGHT 2025/2026 ALLRIGHTS RESERVED
ANSWERS 100% PASS
For Profit Organizations - ANS Can lawfully release a patient who does not have the ability to
pay for services (after EMTALA). Serve lower income populations. Owned by investors or
shareholders. Large portion of budget allocated to marketing and advertising.
not-for-profit organizations - ANS Must treat all conditions or people regardless of insurance
or ability to pay. Considered charities by IRS. Do not pay federal or state/local property taxes.
Obligation to the community.
Medicare - ANS National Health Insurance program for people 65 and older, disabled, and
any age with ESRD.
Medicare A - ANS Covers inpatient hospital stays, some hospice and home health care, no
monthly premium
Medicare B - ANS Medical insurance, pays for doctor services and outpatient services, PT/OT
services. Monthly premium.
Medicare C - ANS Often called the advantage plan or choice plan. Includes A and B, most
include D. May offer dental, vision, and wellness
Medicare D - ANS Prescription drug coverage. Monthly premium. Available to everyone,
must join Medicare plan that includes part D
pg. 1 @COPYRIGHT 2025/2026 ALLRIGHTS RESERVED
,Medicaid - ANS A federal and state assistance program that pays for health care services for
people who cannot afford them. Low-income children, pregnant women, and elderly. Pays long
term care.
Affordable Care Act - ANS An expansion of medicaid, most of employers must provide health
insurance, have insurance or face surtax, prevents rejection based on pre-existing condition.
Also referred to as "Obamacare", signed into law in 2010. Make affordable health insurance
available to more people.
Payors - ANS Employers, government, insurance companies, people who pay for healthcare
services
Charity Pay - ANS Healthcare system received no reimbursement for services
Health Maintenance Organization (HMO) - ANS an organization that provides comprehensive
medical care to subscribers for a fixed fee. Cost effective care focused on preventative care.
Network, group, staff and independent practice associations.
Preferred Provider Organization (PPO) - ANS Group of healthcare providers that provide
services to a specific group, often at a reduced rate. Cost is higher to use out of network
provider. Help negotiate cost of services between the providers and purchasers.
Diagnosis Related Group (DRGs) - ANS classifies patients by age, diagnosis, surgical
procedure, and other information with hundreds of different categories to predict the use of
hospital resources, including length of stay, resulting in a fixed payment amount
Prospective Payment Systems (PPS) - ANS Required facilities providing services to Medicare
clients to be reimbursed using a fixed-rate system and included monetary incentives to reduce
the length of hospital stays.
pg. 2 @COPYRIGHT 2025/2026 ALLRIGHTS RESERVED
, (Based on diagnosis-related group (DRG) categories)
Social Health Maintenance Organization (SHMO) - ANS special type of health plan that
provides the full range of Medicare benefits offered by standard Medicare HMOs, plus other
services that include the following: prescription drug and chronic care benefits, respite care,
and short-term nursing home care; homemaker, personal care services, and medical
transportation; eyeglasses, hearing aids, and dental benefits
Pay for Performance (P4P) - ANS performance-oriented incentives for hospitals and
physicians to improve the quality of patient healthcare. 4 quality measures - performance,
outcomes, patient satisfaction/experience, structures and technologies (EHR)
Value Based Purchasing - ANS A pay for performance methodology used to reimburse
hospitals based on outcomes. Provided by Centers for Medicare and Medicaid Services.
Incentive payments to acute-care hospitals yearly based on total performance score (TPS)
Budget Cycle - ANS Includes development, monitoring, reporting, justifying and variance
analysis. Four types of budget - revenue, expense, capital, and operating
Revenue - ANS anticipated amount of income during the budget period
Expense - ANS salary and nonsalary, fixed costs (remain constant such as rental fees and
contract fees) and variable costs (fluctuate based on unit activity such as census and acuity)
Capital - ANS equipment and renovation expenses. lifespan of 1 year of greater. consider
cost of item, installation, shipping or delivery charges, service contracts. Amortization (assigning
cost of asset over its lifetime) Depreciation (expensing fixed assets annually)
Operating Budget - ANS Annual budget. Based on past years unit activity predicting for next
year. Revenues and expenses for fiscal year.
pg. 3 @COPYRIGHT 2025/2026 ALLRIGHTS RESERVED
