Healthcare Reimbursement Final Exam Newest 2025/2026
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Terms in this set (192)
There are 3 parties in healthcare Patient or guarantor
reimbursement. Who is the first party?
Which type of reimbursement Capitated payment
methodology is associated with the
abbreviation "PMPM"?
What is an example of a charge that Claim is failing due to potentially incomplete code, including missing
usually would be reviewed by an HIM modifiers.
coder?
Which of the following coding systems CPT
was created for reporting procedures
and services performed by physicians
in clinical practice?
What impact does a hospital acquired If a hospital acquired condition causes a case to be grouped to a higher
condition have on a hospital's Medicare paying DRG, Medicare will only reimburse for the lower paying DRG.
reimbursement?
In the healthcare insurance sector, what Usual Customary and Reasonable
does UCR stand for?
Which statement describes the per Fixed rate for each day a covered member is hospitalized
diem payment method?
Which discounted fee-for-service RBRVS
healthcare payment method does
Medicare use to reimburse physicians?
Which type of RAC review combines Semi-automated
data analysis and submission of medical
records to the RAC?
In the healthcare industry, what is the Reimbursement
term for receiving compensation for
healthcare services that were
previously provided?
To which of the following factors is Employment
health insurance status most closely
linked?
, What is the optimum chart completion Within the bill hold period
window for revenue cycle purposes?
Which of the following is the correct A1234
format for HCPCS Level II codes?
In the United States, what is healthcare Reduction of a person's or a group's exposure to risk for unknown healthcare
insurance? costs by the assumption of that risk by an entity
In the healthcare industry, what is Charge
another term for "fee"?
What is the purpose of a random audit Quality monitoring
of coded data? Select all that apply.
None of the above
QIO
Which of the following entities does
not perform improper payment reviews CERT
for CMS?
RACs
MACs
Correct All of the above
Answers:
Block grants
Which of the following payment
Surgical packages
methods are global?
Bundling
Correct All of the above
Which of the following is an example of Billing for a service not furnished as represented on the claim
fraud?
Which patient registration error can Admission date
appropriately be corrected by HIM
coders, if permitted by policy and
procedures?
Which is an example of a practice that Due to low volume, radiation oncology collects their charges and posts once
will most likely result in late charges? a week.
True or False? The constant trend of True
increased national spending on
healthcare is a concern because as
spending on healthcare increases, the
money available for other sectors of
the economy decreases.
Complete Questions And Correct Answers (Verified
Answers)|Brand New Version!
Save
Terms in this set (192)
There are 3 parties in healthcare Patient or guarantor
reimbursement. Who is the first party?
Which type of reimbursement Capitated payment
methodology is associated with the
abbreviation "PMPM"?
What is an example of a charge that Claim is failing due to potentially incomplete code, including missing
usually would be reviewed by an HIM modifiers.
coder?
Which of the following coding systems CPT
was created for reporting procedures
and services performed by physicians
in clinical practice?
What impact does a hospital acquired If a hospital acquired condition causes a case to be grouped to a higher
condition have on a hospital's Medicare paying DRG, Medicare will only reimburse for the lower paying DRG.
reimbursement?
In the healthcare insurance sector, what Usual Customary and Reasonable
does UCR stand for?
Which statement describes the per Fixed rate for each day a covered member is hospitalized
diem payment method?
Which discounted fee-for-service RBRVS
healthcare payment method does
Medicare use to reimburse physicians?
Which type of RAC review combines Semi-automated
data analysis and submission of medical
records to the RAC?
In the healthcare industry, what is the Reimbursement
term for receiving compensation for
healthcare services that were
previously provided?
To which of the following factors is Employment
health insurance status most closely
linked?
, What is the optimum chart completion Within the bill hold period
window for revenue cycle purposes?
Which of the following is the correct A1234
format for HCPCS Level II codes?
In the United States, what is healthcare Reduction of a person's or a group's exposure to risk for unknown healthcare
insurance? costs by the assumption of that risk by an entity
In the healthcare industry, what is Charge
another term for "fee"?
What is the purpose of a random audit Quality monitoring
of coded data? Select all that apply.
None of the above
QIO
Which of the following entities does
not perform improper payment reviews CERT
for CMS?
RACs
MACs
Correct All of the above
Answers:
Block grants
Which of the following payment
Surgical packages
methods are global?
Bundling
Correct All of the above
Which of the following is an example of Billing for a service not furnished as represented on the claim
fraud?
Which patient registration error can Admission date
appropriately be corrected by HIM
coders, if permitted by policy and
procedures?
Which is an example of a practice that Due to low volume, radiation oncology collects their charges and posts once
will most likely result in late charges? a week.
True or False? The constant trend of True
increased national spending on
healthcare is a concern because as
spending on healthcare increases, the
money available for other sectors of
the economy decreases.
