Comprehensive Test- Principals of
Healthcare Reimbursement and Revenue
Cycle Management Review UPDATED
Exam Questions and CORRECT Answers
The US healthcare sector represents a significant portion of the US economy. The trend of
_________ spending on healthcare has been consistent for more than a decade. - Correct
Answer- increased
The goal of revenue integrity is to produce a claim that is __________. - Correct 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 ________. - Correct Answer-
Provider; third-party payer
In the US, what is health insurance? - Correct 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 ________. - Correct Answer- Patient;
employer
Which of the following is not a principle of revenue integrity? - Correct Answer- No
oversight
In this healthcare delivery model, the insurance company determines that contribution
amount that is not based on the policyholder's income: - Correct 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: -
Correct 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: - Correct Answer- Social
insurance model
Which of the following is a key factor in establishing a highly ethical culture that promotes
honesty and openness? - Correct Answer- Transparency
Which of the following types of care represent healthcare services not delivered by MCOs? -
Correct Answer- Experimental devices
What is the term that means evaluating, for a healthcare service, the appropriateness of its
setting and its level of service? - Correct 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? - Correct Answer- Risk pool
All of the following activities are steps in medical necessity and utilization review except: -
Correct Answer- Administrative review
All of the following functions are ways that MCOs work toward their goal of controlling cost
except: - Correct 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? - Correct Answer- Considered to be good medical practice by the
physician providing the service
Once the maximum out-of-pocket benefit is activated, all covered healthcare services for that
policyholder or beneficiary are paid at 100 percent by the health insurance plan. The
policyholder is not liable for _________ beyond the maximum out-of-pocket amount. -
Correct Answer- Cost sharing amounts
Managed care plans control beneficiary choice of provider. On the continuum of control,
which type of managed care organization has the most control and, therefore, has the greatest
limitations on a beneficiary seeing a provider that is not in-network? - Correct Answer-
Health maintenance organization
Healthcare Reimbursement and Revenue
Cycle Management Review UPDATED
Exam Questions and CORRECT Answers
The US healthcare sector represents a significant portion of the US economy. The trend of
_________ spending on healthcare has been consistent for more than a decade. - Correct
Answer- increased
The goal of revenue integrity is to produce a claim that is __________. - Correct 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 ________. - Correct Answer-
Provider; third-party payer
In the US, what is health insurance? - Correct 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 ________. - Correct Answer- Patient;
employer
Which of the following is not a principle of revenue integrity? - Correct Answer- No
oversight
In this healthcare delivery model, the insurance company determines that contribution
amount that is not based on the policyholder's income: - Correct 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: -
Correct 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: - Correct Answer- Social
insurance model
Which of the following is a key factor in establishing a highly ethical culture that promotes
honesty and openness? - Correct Answer- Transparency
Which of the following types of care represent healthcare services not delivered by MCOs? -
Correct Answer- Experimental devices
What is the term that means evaluating, for a healthcare service, the appropriateness of its
setting and its level of service? - Correct 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? - Correct Answer- Risk pool
All of the following activities are steps in medical necessity and utilization review except: -
Correct Answer- Administrative review
All of the following functions are ways that MCOs work toward their goal of controlling cost
except: - Correct 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? - Correct Answer- Considered to be good medical practice by the
physician providing the service
Once the maximum out-of-pocket benefit is activated, all covered healthcare services for that
policyholder or beneficiary are paid at 100 percent by the health insurance plan. The
policyholder is not liable for _________ beyond the maximum out-of-pocket amount. -
Correct Answer- Cost sharing amounts
Managed care plans control beneficiary choice of provider. On the continuum of control,
which type of managed care organization has the most control and, therefore, has the greatest
limitations on a beneficiary seeing a provider that is not in-network? - Correct Answer-
Health maintenance organization
