HIMA 240 Final Exam |Questions and Answers Latest Updated 2026/2027 (Graded
A+)- American Public University
Question 1 point
In which type of healthcare payment method does the healthcare plan pay for each service that a provider
renders?
Question options:
Episode-of-care reimbursement
Block grant
Fee-for-service reimbursement
Global payment
Question 2 point
In which type of reimbursement methodology does the health insurance company have the greatest degree of
risk?
Question options:
Capitated payment
Global payment
Block grant
Retrospective
Question 3 point
All of the following entities are voluntary healthcare insurance except:
Question options:
Private healthcare insurance plans
Commercial healthcare insurance plans
Medicare
Blue Cross and Blue Shield
Question 4 point
In the healthcare industry, what is another term for "charge"?
Question options:
, Fee
Discount
Capitated rate
Reimbursement
Question 5 point
MS-DRG relationships comparing with MCC or CC (major
complications/comorbidities/complications/comorbidities) to without MCC/CC MS-DRGs for the same clinical
condition should be reviewed because:
Question options:
MCC/CCs can be over-coded by coders
MCC/CCs can be under-coded by coders
MCC/CCs should not be reported by coders
Both a and b are correct
a, b, and c are all correct
Question 6 point
To which of the following factors is health insurance status most closely linked?
Question options:
Demographics
Community rating
Historical context
Employment
Question 7 point
Which governmental fraud and abuse effort focused on recouping lost funds for the Medicare Program due to
inaccurate coding and billing? $188 million were recovered during the first two years of this effort.
Question options:
Hospital Payment Monitoring Program
OIG Compliance Program Guidance
, Operation Restore Trust
Medicare Integrity Program
Question 8 point
In which type of healthcare payment method does the healthcare plan recompense providers with a fixed rate
for each day a covered member is hospitalized?
Question options:
Traditional
Episode-of-care
Per diem
Fee-for-service
Question 9 point
Which of the following services has the highest likelihood of being a "covered service"?
Question options:
Preexisting condition
Experimental
Medically necessary
Cosmetic
Question 10 point
All of the following are discounted fee-for-service healthcare payment methods except:
Question options:
ACO (correct answer)
CPR
RBRVS
UCR
Question 11 point
Under MS-DRGs, all of the following factors influence a facility's case-mix index, except:
Question options:
A+)- American Public University
Question 1 point
In which type of healthcare payment method does the healthcare plan pay for each service that a provider
renders?
Question options:
Episode-of-care reimbursement
Block grant
Fee-for-service reimbursement
Global payment
Question 2 point
In which type of reimbursement methodology does the health insurance company have the greatest degree of
risk?
Question options:
Capitated payment
Global payment
Block grant
Retrospective
Question 3 point
All of the following entities are voluntary healthcare insurance except:
Question options:
Private healthcare insurance plans
Commercial healthcare insurance plans
Medicare
Blue Cross and Blue Shield
Question 4 point
In the healthcare industry, what is another term for "charge"?
Question options:
, Fee
Discount
Capitated rate
Reimbursement
Question 5 point
MS-DRG relationships comparing with MCC or CC (major
complications/comorbidities/complications/comorbidities) to without MCC/CC MS-DRGs for the same clinical
condition should be reviewed because:
Question options:
MCC/CCs can be over-coded by coders
MCC/CCs can be under-coded by coders
MCC/CCs should not be reported by coders
Both a and b are correct
a, b, and c are all correct
Question 6 point
To which of the following factors is health insurance status most closely linked?
Question options:
Demographics
Community rating
Historical context
Employment
Question 7 point
Which governmental fraud and abuse effort focused on recouping lost funds for the Medicare Program due to
inaccurate coding and billing? $188 million were recovered during the first two years of this effort.
Question options:
Hospital Payment Monitoring Program
OIG Compliance Program Guidance
, Operation Restore Trust
Medicare Integrity Program
Question 8 point
In which type of healthcare payment method does the healthcare plan recompense providers with a fixed rate
for each day a covered member is hospitalized?
Question options:
Traditional
Episode-of-care
Per diem
Fee-for-service
Question 9 point
Which of the following services has the highest likelihood of being a "covered service"?
Question options:
Preexisting condition
Experimental
Medically necessary
Cosmetic
Question 10 point
All of the following are discounted fee-for-service healthcare payment methods except:
Question options:
ACO (correct answer)
CPR
RBRVS
UCR
Question 11 point
Under MS-DRGs, all of the following factors influence a facility's case-mix index, except:
Question options:
