Billing and Reimbursement in Healthcare
Exam 2026 Questions and Answers
What are the two major types of payers in healthcare? - Correct answer-
Commercial and government health plans.
How are government insurance plans classified? - Correct answer-They are
classified as federal or state programs.
What is Medicare? - Correct answer-A federal government program for individuals
over 65, those with qualifying disabilities, or those with end-stage renal disease.
What does Medicaid refer to? - Correct answer-State benefit programs available to
qualifying individuals, with qualifications varying by state.
What is TRICARE? - Correct answer-A federal payer for military members and
eligible family members.
What types of insurance might be used for specific conditions or injuries? - Correct
answer-Auto insurance, MedPay policy, and workers' compensation.
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, What is the importance of confirming coverage with auto insurance or workers'
compensation? - Correct answer-To avoid claim denial and delays in
reimbursement.
What is the fee-for-service payment model? - Correct answer-A model where the
provider is paid for each service or procedure performed for the patient.
What codes are reported in the fee-for-service model? - Correct answer-CPT,
HCPCS, and ICD-10-CM codes.
What is the pay-for-performance (P4P) reimbursement model? - Correct answer-A
model that focuses on value-based care rather than volume-based care, using
quality and clinical measures.
What is the goal of value-based care models? - Correct answer-To improve patient
outcomes and reduce hospitalizations by providing quality care.
What are examples of value-based care models? - Correct answer-Accountable
care organizations (ACO) and patient-centered medical homes (PCMH).
What is capitation in healthcare payment models? - Correct answer-A model where
a managed care organization agrees to a set reimbursement amount per patient, per
month.
©COPYRIGHT 2025, ALL RIGHTS RESERVED 2
Exam 2026 Questions and Answers
What are the two major types of payers in healthcare? - Correct answer-
Commercial and government health plans.
How are government insurance plans classified? - Correct answer-They are
classified as federal or state programs.
What is Medicare? - Correct answer-A federal government program for individuals
over 65, those with qualifying disabilities, or those with end-stage renal disease.
What does Medicaid refer to? - Correct answer-State benefit programs available to
qualifying individuals, with qualifications varying by state.
What is TRICARE? - Correct answer-A federal payer for military members and
eligible family members.
What types of insurance might be used for specific conditions or injuries? - Correct
answer-Auto insurance, MedPay policy, and workers' compensation.
©COPYRIGHT 2025, ALL RIGHTS RESERVED 1
, What is the importance of confirming coverage with auto insurance or workers'
compensation? - Correct answer-To avoid claim denial and delays in
reimbursement.
What is the fee-for-service payment model? - Correct answer-A model where the
provider is paid for each service or procedure performed for the patient.
What codes are reported in the fee-for-service model? - Correct answer-CPT,
HCPCS, and ICD-10-CM codes.
What is the pay-for-performance (P4P) reimbursement model? - Correct answer-A
model that focuses on value-based care rather than volume-based care, using
quality and clinical measures.
What is the goal of value-based care models? - Correct answer-To improve patient
outcomes and reduce hospitalizations by providing quality care.
What are examples of value-based care models? - Correct answer-Accountable
care organizations (ACO) and patient-centered medical homes (PCMH).
What is capitation in healthcare payment models? - Correct answer-A model where
a managed care organization agrees to a set reimbursement amount per patient, per
month.
©COPYRIGHT 2025, ALL RIGHTS RESERVED 2
