Healthcare Settings, Claim
Cycle, and Claims
Processing (ME2550) exam
Questions And Answers
[COMPANY NAME] [Company address]
, Healthcare Settings, Claim Cycle,
and Claims Processing (ME2550)
exam Questions And Answers
Revenue cycle management - correct answer diagnosis-related group (DRG) coding validation and claims
denial procedures, which are vital to recovering otherwise lost revenue to the facility (or reimbursing
overpayments received by the hospital to third-party payers).
Health Insurance Claim - correct answer documentation submitted to an insurance plan requesting
reimbursement for health care services provided
Hold Harmless Clause - correct answer policy that the patient is not responsible for paying what the
insurance plan denies.
Center for Medicare and Medicaid Services (CMS) - correct answer - An administrative agency within the
federal Department of Health and Human Services (DHHS).
-CMS publishes the Healthcare Common Procedure Coding System (HCPCS)
Coding - correct answer process of reporting diagnoses, procedures, and services as numeric and
alphanumeric characters (called codes) on the insurance claim.
Overview of ICD-10-CM and ICD-10-PCS - correct answer •ICD-10: Published by WHO to classify
mortality (death) data from death certificates
•ICD-10-CM: Created by NCHS to classify morbidity (disease) data from all settings
•ICD-10-PCS: Created by CMS and used for inpatient hospital settings only
International Classification Of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) - correct answer
- Created by the National Center for Health Statistics (NCHS) classify MORBIDITY (disease) date from all
setting
Cycle, and Claims
Processing (ME2550) exam
Questions And Answers
[COMPANY NAME] [Company address]
, Healthcare Settings, Claim Cycle,
and Claims Processing (ME2550)
exam Questions And Answers
Revenue cycle management - correct answer diagnosis-related group (DRG) coding validation and claims
denial procedures, which are vital to recovering otherwise lost revenue to the facility (or reimbursing
overpayments received by the hospital to third-party payers).
Health Insurance Claim - correct answer documentation submitted to an insurance plan requesting
reimbursement for health care services provided
Hold Harmless Clause - correct answer policy that the patient is not responsible for paying what the
insurance plan denies.
Center for Medicare and Medicaid Services (CMS) - correct answer - An administrative agency within the
federal Department of Health and Human Services (DHHS).
-CMS publishes the Healthcare Common Procedure Coding System (HCPCS)
Coding - correct answer process of reporting diagnoses, procedures, and services as numeric and
alphanumeric characters (called codes) on the insurance claim.
Overview of ICD-10-CM and ICD-10-PCS - correct answer •ICD-10: Published by WHO to classify
mortality (death) data from death certificates
•ICD-10-CM: Created by NCHS to classify morbidity (disease) data from all settings
•ICD-10-PCS: Created by CMS and used for inpatient hospital settings only
International Classification Of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) - correct answer
- Created by the National Center for Health Statistics (NCHS) classify MORBIDITY (disease) date from all
setting
