Page 1 of 57
HFMA: HEALTHCARE FINANCIAL MANAGEMENT
ASSOCIATION EXAM (2025) QUESTIONS AND
VERIFIED ANSWERS
provider - general .....ANSWER.....A party rendering medical
care such as a physician or hopsital
facilities provider .....ANSWER.....Includes hospitals, skilled nursing
facilities, assisted living facilities, home health agencies, and
ambulatory centers
professional provider .....ANSWER.....includes physicians,
pharmacists, nurses, therapists, and allied health professionals
primary care .....ANSWER.....primary care physicians are usually
trained in family practice, general practice, general internal
medicine, and pediatrics. Physicians serving in primary care roles
usually treat common medical conditions or injuries, and often
provide preventive health screenings. They are often viewed as
,Page 2 of 57
serving as a coordinator of a patient's care, assessing a patient's
condition, and treating if a simple condition, or referring a
patient to a specialist physician.
specialist .....ANSWER.....specialists normally do not provide
primary care services, instead focusing their work based on in-
depth training in different diseases, body systems or types of
health care service
third party payer .....ANSWER.....a health insurance plan paying
for the services
out-of-pocket-payment .....ANSWER.....payments by patients that
can be required as a part of a health insurance plan are:
deductible, copayment, and coinsurance
deductible .....ANSWER.....the deductible is a pre-determined
amount that the patient pays before the insurer begins to pay
for service
,Page 3 of 57
coinsurance .....ANSWER.....corinsurance is a percentage of the
insurance payment amount that is paid by the patient, along with
the amount paid by the insurerer
indemnify .....ANSWER.....payment on behalf of the patient - costs
covered under the insurance contract between the patient and
the insurer
claim .....ANSWER.....a bill for services provided
pre-authroization .....ANSWER.....permission by the insurer to
render services to the patient before actually treating the
patient. This includes verification of payment for the service by
the insurer
benefit payment .....ANSWER.....once the insurer has determined
the claim is appropriate, a payment is made to the provider. This
payment is officially termed a benefit payment
beneficiary .....ANSWER.....insurers usually refer to the patient for
which services are paid as the beneficiary
, Page 4 of 57
a covered benefit .....ANSWER.....the services for which the
insurer will pay are usually referred to as a covered benefit
denial .....ANSWER.....the insurer may determine that the claim
from the provider is not a covered benefit and will not pay the
claim to the provider
remittance advice .....ANSWER.....the information an insurer
provides on the payment decision
Medicare A .....ANSWER.....funded primarily by Medicare taxes
paid by current workers to fund the costs of current
beneficiaries. Patients are usually eligible for Medicare Part _ if
they are a US citizen over age 65, disabled or have End Stage
Renal Development and have paid Medicare wage taxes for at
least forty (40) calendar quarters - known as categorical
eligibility. Medicare Part _ covers inpatient hospital services,
certain organ transplants, ESRD treatment, inpatient skilled
nursing facility care, home health care and hospice care
HFMA: HEALTHCARE FINANCIAL MANAGEMENT
ASSOCIATION EXAM (2025) QUESTIONS AND
VERIFIED ANSWERS
provider - general .....ANSWER.....A party rendering medical
care such as a physician or hopsital
facilities provider .....ANSWER.....Includes hospitals, skilled nursing
facilities, assisted living facilities, home health agencies, and
ambulatory centers
professional provider .....ANSWER.....includes physicians,
pharmacists, nurses, therapists, and allied health professionals
primary care .....ANSWER.....primary care physicians are usually
trained in family practice, general practice, general internal
medicine, and pediatrics. Physicians serving in primary care roles
usually treat common medical conditions or injuries, and often
provide preventive health screenings. They are often viewed as
,Page 2 of 57
serving as a coordinator of a patient's care, assessing a patient's
condition, and treating if a simple condition, or referring a
patient to a specialist physician.
specialist .....ANSWER.....specialists normally do not provide
primary care services, instead focusing their work based on in-
depth training in different diseases, body systems or types of
health care service
third party payer .....ANSWER.....a health insurance plan paying
for the services
out-of-pocket-payment .....ANSWER.....payments by patients that
can be required as a part of a health insurance plan are:
deductible, copayment, and coinsurance
deductible .....ANSWER.....the deductible is a pre-determined
amount that the patient pays before the insurer begins to pay
for service
,Page 3 of 57
coinsurance .....ANSWER.....corinsurance is a percentage of the
insurance payment amount that is paid by the patient, along with
the amount paid by the insurerer
indemnify .....ANSWER.....payment on behalf of the patient - costs
covered under the insurance contract between the patient and
the insurer
claim .....ANSWER.....a bill for services provided
pre-authroization .....ANSWER.....permission by the insurer to
render services to the patient before actually treating the
patient. This includes verification of payment for the service by
the insurer
benefit payment .....ANSWER.....once the insurer has determined
the claim is appropriate, a payment is made to the provider. This
payment is officially termed a benefit payment
beneficiary .....ANSWER.....insurers usually refer to the patient for
which services are paid as the beneficiary
, Page 4 of 57
a covered benefit .....ANSWER.....the services for which the
insurer will pay are usually referred to as a covered benefit
denial .....ANSWER.....the insurer may determine that the claim
from the provider is not a covered benefit and will not pay the
claim to the provider
remittance advice .....ANSWER.....the information an insurer
provides on the payment decision
Medicare A .....ANSWER.....funded primarily by Medicare taxes
paid by current workers to fund the costs of current
beneficiaries. Patients are usually eligible for Medicare Part _ if
they are a US citizen over age 65, disabled or have End Stage
Renal Development and have paid Medicare wage taxes for at
least forty (40) calendar quarters - known as categorical
eligibility. Medicare Part _ covers inpatient hospital services,
certain organ transplants, ESRD treatment, inpatient skilled
nursing facility care, home health care and hospice care
