1 | Page
Revenue Cycle Questions and Answers 2026
Latest Update
payer Ans: the person responsible for the patient's bill
subscriber Ans: the primary person covered by an insurance plan
Premium Ans: an amount to be paid for an insurance policy.
Revenue Cycle Ans: The process of how patient financial and
health information moves into, through, and out of the healthcare
facility, culminating with the facility receiving reimbursement for
services provided.
Deductible Ans: Amount you must pay before you begin receiving
any benefits from your insurance company
Copay Ans: an out-of-pocket fee paid by a person with health
insurance at the time a covered service, such as an office visit or a
prescription, is received
Coinsurance Ans: the sharing of expenses by the policyholder and
the insurance company
out-of-pocket limit Ans: limits the amount of money the
policyholder must pay for the co-insurance each year
fee-for-service Ans: a system under which doctors and hospitals
receive a payment for each service they provide
© 2025 All rights reserved
, 2 | Page
fee schedule Ans: A list of charges or established allowances for
specific medical services and procedures
Allowable Amount Ans: The limit that most insurance plans put
on the amount that will be allowed for reimbursement for a service
or procedure.
charges Ans: amounts a provider bills for the services performed
Prospective Payment System (PPS) Ans: System for Medicare
patients by which a predetermined level of reimbursement is
established before services are provided
Resource-Based Relative Value Scale (RBRVS) Ans: A
reimbursement method for physicians (Medicare B) that looks at
their work, practice and liability expense in addition to their
geographic location
Ambulatory Payment Classification (APC) Ans: Prospective
payment system used to calculate reimbursement for outpatient
care according to similar clinical characteristics and in terms of
resources required.
Diagnosis-related groups (DRGs) Ans: classification of patients by
major medical diagnosis for the purpose of standardizing health
care costs for inpatient stays
grouper Ans: The computer software program that assigns DRGs
of discharged patients using the following information: patient's
age, sex, principal diagnosis, complications/comorbid conditions,
principal procedure, and discharge status.
© 2025 All rights reserved
Revenue Cycle Questions and Answers 2026
Latest Update
payer Ans: the person responsible for the patient's bill
subscriber Ans: the primary person covered by an insurance plan
Premium Ans: an amount to be paid for an insurance policy.
Revenue Cycle Ans: The process of how patient financial and
health information moves into, through, and out of the healthcare
facility, culminating with the facility receiving reimbursement for
services provided.
Deductible Ans: Amount you must pay before you begin receiving
any benefits from your insurance company
Copay Ans: an out-of-pocket fee paid by a person with health
insurance at the time a covered service, such as an office visit or a
prescription, is received
Coinsurance Ans: the sharing of expenses by the policyholder and
the insurance company
out-of-pocket limit Ans: limits the amount of money the
policyholder must pay for the co-insurance each year
fee-for-service Ans: a system under which doctors and hospitals
receive a payment for each service they provide
© 2025 All rights reserved
, 2 | Page
fee schedule Ans: A list of charges or established allowances for
specific medical services and procedures
Allowable Amount Ans: The limit that most insurance plans put
on the amount that will be allowed for reimbursement for a service
or procedure.
charges Ans: amounts a provider bills for the services performed
Prospective Payment System (PPS) Ans: System for Medicare
patients by which a predetermined level of reimbursement is
established before services are provided
Resource-Based Relative Value Scale (RBRVS) Ans: A
reimbursement method for physicians (Medicare B) that looks at
their work, practice and liability expense in addition to their
geographic location
Ambulatory Payment Classification (APC) Ans: Prospective
payment system used to calculate reimbursement for outpatient
care according to similar clinical characteristics and in terms of
resources required.
Diagnosis-related groups (DRGs) Ans: classification of patients by
major medical diagnosis for the purpose of standardizing health
care costs for inpatient stays
grouper Ans: The computer software program that assigns DRGs
of discharged patients using the following information: patient's
age, sex, principal diagnosis, complications/comorbid conditions,
principal procedure, and discharge status.
© 2025 All rights reserved
