PRINCIPALS OF HEALTHCARE
REIMBURSEMENT AND REVENUE CYCLE
MANAGEMENT UPDATED ACTUAL
QUESTIONS AND CORRECT ANSWERS
COMPLETE STUDY GUIDE
●● The goal of revenue integrity is to produce a claim that is
__________.
Answer: Clean, complete, and compliant
●● A physician office submitting an invoice (claim) for payment when
the patient has health insurance is an example of a transaction between
________ and ________.
Answer: Provider; third-party payer
●● In the US, what is health insurance?
Answer: Reduction of a person's or a group's exposure to risk for
unknown healthcare costs by the assumption of that risk by an entity
●● An employee paying for 40 percent of the insurance premium
through payroll processing is an example of a transaction between
________ and ________.
Answer: Patient; employer
,●● Which of the following is not a principle of revenue integrity?
Answer: No oversight
●● In this healthcare delivery model, the insurance company determines
that contribution amount that is not based on the policyholder's income:
Answer: Private health insurance model
●● Successful RCM programs use this type of approach, which
promotes collaboration amount various clinical departments and
emphasizes and education strategy for all members:
Answer: Multidisciplinary model
●● In this healthcare delivery model, employees and employers
contribute an income-based amount of money to funds that are regulated
by the government:
Answer: Social insurance model
●● Which of the following is a key factor in establishing a highly ethical
culture that promotes honesty and openness?
Answer: Transparency
●● Which of the following types of care represent healthcare services
not delivered by MCOs?
, Answer: Experimental devices
●● What is the term that means evaluating, for a healthcare service, the
appropriateness of its setting and its level of service?
Answer: Utilization review
●● In the healthcare sector, what is the term for a group of individual
entities, such as individual persons, employers, or associations, whose
healthcare costs are combined for evaluating financial history and
estimating future costs?
Answer: Risk pool
●● All of the following activities are steps in medical necessity and
utilization review except:
Answer: Administrative review
●● All of the following functions are ways that MCOs work toward their
goal of controlling cost except:
Answer: Use of evidence based clinical practice guidelines
●● Medicare has four criteria to define medically necessary services.
Which of the following is not one of the four criteria?
Answer: Considered to be good medical practice by the physician
providing the service
REIMBURSEMENT AND REVENUE CYCLE
MANAGEMENT UPDATED ACTUAL
QUESTIONS AND CORRECT ANSWERS
COMPLETE STUDY GUIDE
●● The goal of revenue integrity is to produce a claim that is
__________.
Answer: Clean, complete, and compliant
●● A physician office submitting an invoice (claim) for payment when
the patient has health insurance is an example of a transaction between
________ and ________.
Answer: Provider; third-party payer
●● In the US, what is health insurance?
Answer: Reduction of a person's or a group's exposure to risk for
unknown healthcare costs by the assumption of that risk by an entity
●● An employee paying for 40 percent of the insurance premium
through payroll processing is an example of a transaction between
________ and ________.
Answer: Patient; employer
,●● Which of the following is not a principle of revenue integrity?
Answer: No oversight
●● In this healthcare delivery model, the insurance company determines
that contribution amount that is not based on the policyholder's income:
Answer: Private health insurance model
●● Successful RCM programs use this type of approach, which
promotes collaboration amount various clinical departments and
emphasizes and education strategy for all members:
Answer: Multidisciplinary model
●● In this healthcare delivery model, employees and employers
contribute an income-based amount of money to funds that are regulated
by the government:
Answer: Social insurance model
●● Which of the following is a key factor in establishing a highly ethical
culture that promotes honesty and openness?
Answer: Transparency
●● Which of the following types of care represent healthcare services
not delivered by MCOs?
, Answer: Experimental devices
●● What is the term that means evaluating, for a healthcare service, the
appropriateness of its setting and its level of service?
Answer: Utilization review
●● In the healthcare sector, what is the term for a group of individual
entities, such as individual persons, employers, or associations, whose
healthcare costs are combined for evaluating financial history and
estimating future costs?
Answer: Risk pool
●● All of the following activities are steps in medical necessity and
utilization review except:
Answer: Administrative review
●● All of the following functions are ways that MCOs work toward their
goal of controlling cost except:
Answer: Use of evidence based clinical practice guidelines
●● Medicare has four criteria to define medically necessary services.
Which of the following is not one of the four criteria?
Answer: Considered to be good medical practice by the physician
providing the service
