HIMS 5620 Exam 1 Questions with Correct Answers Latest Update 2026/2027
reimbursement - Answers amount paid to a healthcare provider for services provided to a
patient
revenue cycle - Answers regular set of tasks and activities that produces reimbursement
(revenue)
revenue cycle management (RCM) - Answers the supervisor of all the administrative and clinical
functions that contribute to the capture, management, and collection of patient service
reimbursement
insurance - Answers a system of reducing a person's exposure to risk of loss by having another
party, an insurance company, assume the risk
three national models for delivering healthcare services - Answers social insurance, national
health insurance, private health insurance
social insurance model (Bismark model) - Answers universal healthcare coverage for a set of
benefits defined by the government, which may include preventative and primary care,
hospitalization, mental health benefits, and prescription drugs
every worker and employer must contribute to sickness funds who redistribute the money per
government regulations (form of social security)
the amount contributed is based on income
national health service model (Beveridge model) - Answers single-payer health system
one entity, can be the government or a government-run organization acts as an administrator of
a single insurance pool, collects all health fees and pays all health costs for an entire population
financed by country's revenue that come from taxes based on income
private health insurance model - Answers collect premiums to create a pool of money, used to
pay health claims
workers and employers contribute to pool, insurance company determines contribution which is
, NOT based on income
third-party payer - Answers an insurance company or health agency that pays the physician,
clinic, or other provider for the care or services rendered to the patient
premium - Answers the amount of money that a policyholder or beneficiary must periodically
pay an insurance company in return for healthcare coverage
risk pool - Answers group of individual entities, such s individuals, employers, or associations
whose healthcare costs are combined for evaluating financial history and estimating future
costs
policyholder - Answers individual or entity that purchases health insurance coverage
beneficiary - Answers an individual who is eligible for benefits from a health plan
guarantor - Answers person responsible for the patient's health costs
revenue integrity - Answers performing revenue cycle duties to obtain operational efficiency,
compliance adherence, and legitimate reimbursement
goals to producing a claim - Answers clean - free of errors
complete - all services and supplies reflected
compliant - adhering to contract requirements, regulations, and laws
integrated revenue cycle (IRC) - Answers the coordination of revenue cycle activities under a
single leadership and team structure
three primary benefits of IRC - Answers reduced cost to collect, performance consistency, and
coordinated strategic goals
Which one of the three models of healthcare delivery is used in the US? - Answers private health
insurance model
Describe the healthcare spending trend in the US over the past decade. - Answers Healthcare
spending in the US has increased over the past decade. However, the percentage of change in
healthcare spending appears to be decreasing over the past decade.
Provide two examples of transactions that occur between the provider and third-party payer. -
Answers A third-party payer is an insurance company or other health agency that pays the
provider for the services given to the patient. Two examples of transactions that occur between
the provider and third-party payer are the provider submitting a statement to the third-party
payer for services the patient obtained and the third-party payer submitting payments for the
patient based on a contractual relationship it may hold with the provider.
reimbursement - Answers amount paid to a healthcare provider for services provided to a
patient
revenue cycle - Answers regular set of tasks and activities that produces reimbursement
(revenue)
revenue cycle management (RCM) - Answers the supervisor of all the administrative and clinical
functions that contribute to the capture, management, and collection of patient service
reimbursement
insurance - Answers a system of reducing a person's exposure to risk of loss by having another
party, an insurance company, assume the risk
three national models for delivering healthcare services - Answers social insurance, national
health insurance, private health insurance
social insurance model (Bismark model) - Answers universal healthcare coverage for a set of
benefits defined by the government, which may include preventative and primary care,
hospitalization, mental health benefits, and prescription drugs
every worker and employer must contribute to sickness funds who redistribute the money per
government regulations (form of social security)
the amount contributed is based on income
national health service model (Beveridge model) - Answers single-payer health system
one entity, can be the government or a government-run organization acts as an administrator of
a single insurance pool, collects all health fees and pays all health costs for an entire population
financed by country's revenue that come from taxes based on income
private health insurance model - Answers collect premiums to create a pool of money, used to
pay health claims
workers and employers contribute to pool, insurance company determines contribution which is
, NOT based on income
third-party payer - Answers an insurance company or health agency that pays the physician,
clinic, or other provider for the care or services rendered to the patient
premium - Answers the amount of money that a policyholder or beneficiary must periodically
pay an insurance company in return for healthcare coverage
risk pool - Answers group of individual entities, such s individuals, employers, or associations
whose healthcare costs are combined for evaluating financial history and estimating future
costs
policyholder - Answers individual or entity that purchases health insurance coverage
beneficiary - Answers an individual who is eligible for benefits from a health plan
guarantor - Answers person responsible for the patient's health costs
revenue integrity - Answers performing revenue cycle duties to obtain operational efficiency,
compliance adherence, and legitimate reimbursement
goals to producing a claim - Answers clean - free of errors
complete - all services and supplies reflected
compliant - adhering to contract requirements, regulations, and laws
integrated revenue cycle (IRC) - Answers the coordination of revenue cycle activities under a
single leadership and team structure
three primary benefits of IRC - Answers reduced cost to collect, performance consistency, and
coordinated strategic goals
Which one of the three models of healthcare delivery is used in the US? - Answers private health
insurance model
Describe the healthcare spending trend in the US over the past decade. - Answers Healthcare
spending in the US has increased over the past decade. However, the percentage of change in
healthcare spending appears to be decreasing over the past decade.
Provide two examples of transactions that occur between the provider and third-party payer. -
Answers A third-party payer is an insurance company or other health agency that pays the
provider for the services given to the patient. Two examples of transactions that occur between
the provider and third-party payer are the provider submitting a statement to the third-party
payer for services the patient obtained and the third-party payer submitting payments for the
patient based on a contractual relationship it may hold with the provider.
