Healthcare Reimbursement Final Study
Guide UPDATED Study Guide
QUESTIONS AND CORRET ANSWSER
In which type of reimbursement methodology does the health insurance
company have the greatest degree of risk?
a. Capitated payment
b. Global payment
c. Block grant
d. Retrospective - CORRECT ANSWERS d. Retrospective
In the healthcare industry, what is another term for "fee"?
a. Capitated rate
b. Charge
c. Discount
d. Reimbursement - CORRECT ANSWERS b. Charge
In the United States, what is healthcare insurance?
a. Federal program to provide medical care and services to indigent US citizens
b. State programs to provide medical care and services to deserving individuals
c. 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
d. Set of negotiated guarantees that all healthcare expenses of a risk pool will be
covered by employers - CORRECT ANSWERS c. 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
All of the following phenomena are considered "life events" except:
a. Birth
b. Marriage
c. Adoption of a child
d. Illness - CORRECT ANSWERS d. Illness
To which of the following factors is health insurance status most closely linked?
a. Access
b. Employment
c. Gender
d. Need - CORRECT ANSWERS b. Employment
Which of the following coding systems was created for reporting procedures
and services performed by physicians in clinical practice?
a. ICD-9-CM
b. CPT
c. ICD-10-PCS
d. HCPCS Level II - CORRECT ANSWERS b. CPT
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?
,a. Limitation
b. Risk pool
c. In-network
d. Wrap-around - CORRECT ANSWERS b. Risk pool
An annual amount of money that the policyholder must incur (and pay) before
the health insurance will assume liability for the remaining charges or covered
expenses is known as a _____________ - CORRECT ANSWERS
deductible
Explain Risk Pools, how they work and what are the pros and cons. -
CORRECT ANSWERS Group of individual entities, such as individual
persons, employers, or associations, whose healthcare costs are combined for
evaluating financial history and estimating future costs.
Large-employer pools: Employees of one employer, typically 1,000 members or
more. Large and diverse.
Multiple-employer pools: Employees from several midsize employers or small
employers or groups of association. Smaller and less diverse than the large-
employer pool.
Individual Pools: Self-employed people or people who work for companies that
do not offer healthcare insurance. Least diverse because people tend to be
similar.
The coding system that is used primarily for reporting diagnoses for hospital
inpatients is known as:
a. ICD-10-CM
, b. CPT
c. ICD-10-PCS
d. HCPCS Level II - CORRECT ANSWERS a. ICD-10-CM
Which type of healthcare insurance policy provides benefits to a resident
requiring nursing home care and services?
a. Long-term or extended care insurance
b. Accidental death and dismemberment insurance
c. Disability income protection insurance
d. Major medical
e. Medigap - CORRECT ANSWERS a. Long-term or extended care
insurance
What is an Explanation of Benefits (EOB)? - CORRECT ANSWERS
Report sent from a healthcare insurer to the policyholder and to the provider
that describes the healthcare service, its costs, applicable cost sharing, and the
amount the healthcare insurer will cover. The remainder is the policyholder's
responsibility.
What healthcare organization is one of the most influential in the healthcare
sector because it insures nearly one in three Americans?
a. Blue Cross Blue Shield
b. Center of Excellence
c. Title 1
d. American Hospital Association - CORRECT ANSWERS a. Blue
Cross Blue Shield
Guide UPDATED Study Guide
QUESTIONS AND CORRET ANSWSER
In which type of reimbursement methodology does the health insurance
company have the greatest degree of risk?
a. Capitated payment
b. Global payment
c. Block grant
d. Retrospective - CORRECT ANSWERS d. Retrospective
In the healthcare industry, what is another term for "fee"?
a. Capitated rate
b. Charge
c. Discount
d. Reimbursement - CORRECT ANSWERS b. Charge
In the United States, what is healthcare insurance?
a. Federal program to provide medical care and services to indigent US citizens
b. State programs to provide medical care and services to deserving individuals
c. 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
d. Set of negotiated guarantees that all healthcare expenses of a risk pool will be
covered by employers - CORRECT ANSWERS c. 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
All of the following phenomena are considered "life events" except:
a. Birth
b. Marriage
c. Adoption of a child
d. Illness - CORRECT ANSWERS d. Illness
To which of the following factors is health insurance status most closely linked?
a. Access
b. Employment
c. Gender
d. Need - CORRECT ANSWERS b. Employment
Which of the following coding systems was created for reporting procedures
and services performed by physicians in clinical practice?
a. ICD-9-CM
b. CPT
c. ICD-10-PCS
d. HCPCS Level II - CORRECT ANSWERS b. CPT
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?
,a. Limitation
b. Risk pool
c. In-network
d. Wrap-around - CORRECT ANSWERS b. Risk pool
An annual amount of money that the policyholder must incur (and pay) before
the health insurance will assume liability for the remaining charges or covered
expenses is known as a _____________ - CORRECT ANSWERS
deductible
Explain Risk Pools, how they work and what are the pros and cons. -
CORRECT ANSWERS Group of individual entities, such as individual
persons, employers, or associations, whose healthcare costs are combined for
evaluating financial history and estimating future costs.
Large-employer pools: Employees of one employer, typically 1,000 members or
more. Large and diverse.
Multiple-employer pools: Employees from several midsize employers or small
employers or groups of association. Smaller and less diverse than the large-
employer pool.
Individual Pools: Self-employed people or people who work for companies that
do not offer healthcare insurance. Least diverse because people tend to be
similar.
The coding system that is used primarily for reporting diagnoses for hospital
inpatients is known as:
a. ICD-10-CM
, b. CPT
c. ICD-10-PCS
d. HCPCS Level II - CORRECT ANSWERS a. ICD-10-CM
Which type of healthcare insurance policy provides benefits to a resident
requiring nursing home care and services?
a. Long-term or extended care insurance
b. Accidental death and dismemberment insurance
c. Disability income protection insurance
d. Major medical
e. Medigap - CORRECT ANSWERS a. Long-term or extended care
insurance
What is an Explanation of Benefits (EOB)? - CORRECT ANSWERS
Report sent from a healthcare insurer to the policyholder and to the provider
that describes the healthcare service, its costs, applicable cost sharing, and the
amount the healthcare insurer will cover. The remainder is the policyholder's
responsibility.
What healthcare organization is one of the most influential in the healthcare
sector because it insures nearly one in three Americans?
a. Blue Cross Blue Shield
b. Center of Excellence
c. Title 1
d. American Hospital Association - CORRECT ANSWERS a. Blue
Cross Blue Shield
