Page |1
Healthcare Reimbursement Final Exam
Questions and Correct Answers/ Latest
Update / Already Graded
There are 3 parties in healthcare reimbursement. Who is the first
party?
Ans: Patient or guarantor
Which type of reimbursement methodology is associated with the
abbreviation "PMPM"?
Ans: Capitated payment
What is an example of a charge that usually would be reviewed by an
HIM coder?
Ans: Claim is failing due to potentially incomplete code,
including missing modifiers.
Which of the following coding systems was created for reporting
procedures and services performed by physicians in clinical practice?
Ans: CPT
All rights reserved © 2025/ 2026 |
, Page |2
What impact does a hospital acquired condition have on a hospital's
Medicare reimbursement?
Ans: If a hospital acquired condition causes a case to be
grouped to a higher paying DRG, Medicare will only reimburse
for the lower paying DRG.
In the healthcare insurance sector, what does UCR stand for?
Ans: Usual Customary and Reasonable
Which statement describes the per diem payment method?
Ans: Fixed rate for each day a covered member is hospitalized
Which discounted fee-for-service healthcare payment method does
Medicare use to reimburse physicians?
Ans: RBRVS
Which type of RAC review combines data analysis and submission of
medical records to the RAC?
Ans: Semi-automated
All rights reserved © 2025/ 2026 |
, Page |3
In the healthcare industry, what is the term for receiving compensation
for healthcare services that were previously provided?
Ans: Reimbursement
To which of the following factors is health insurance status most
closely linked?
Ans: Employment
What is the optimum chart completion window for revenue cycle
purposes?
Ans: Within the bill hold period
Which of the following is the correct format for HCPCS Level II codes?
Ans: A1234
In the United States, what is healthcare insurance?
Ans: 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
In the healthcare industry, what is another term for "fee"?
All rights reserved © 2025/ 2026 |
, Page |4
Ans: Charge
What is the purpose of a random audit of coded data? Select all that
apply.
Ans: Quality monitoring
Which of the following entities does not perform improper payment
reviews for CMS?
Ans: None of the above
QIO
CERT
RACs
MACs
Which of the following payment methods are global?
Ans: Correct All of the above
Answers:
All rights reserved © 2025/ 2026 |
Healthcare Reimbursement Final Exam
Questions and Correct Answers/ Latest
Update / Already Graded
There are 3 parties in healthcare reimbursement. Who is the first
party?
Ans: Patient or guarantor
Which type of reimbursement methodology is associated with the
abbreviation "PMPM"?
Ans: Capitated payment
What is an example of a charge that usually would be reviewed by an
HIM coder?
Ans: Claim is failing due to potentially incomplete code,
including missing modifiers.
Which of the following coding systems was created for reporting
procedures and services performed by physicians in clinical practice?
Ans: CPT
All rights reserved © 2025/ 2026 |
, Page |2
What impact does a hospital acquired condition have on a hospital's
Medicare reimbursement?
Ans: If a hospital acquired condition causes a case to be
grouped to a higher paying DRG, Medicare will only reimburse
for the lower paying DRG.
In the healthcare insurance sector, what does UCR stand for?
Ans: Usual Customary and Reasonable
Which statement describes the per diem payment method?
Ans: Fixed rate for each day a covered member is hospitalized
Which discounted fee-for-service healthcare payment method does
Medicare use to reimburse physicians?
Ans: RBRVS
Which type of RAC review combines data analysis and submission of
medical records to the RAC?
Ans: Semi-automated
All rights reserved © 2025/ 2026 |
, Page |3
In the healthcare industry, what is the term for receiving compensation
for healthcare services that were previously provided?
Ans: Reimbursement
To which of the following factors is health insurance status most
closely linked?
Ans: Employment
What is the optimum chart completion window for revenue cycle
purposes?
Ans: Within the bill hold period
Which of the following is the correct format for HCPCS Level II codes?
Ans: A1234
In the United States, what is healthcare insurance?
Ans: 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
In the healthcare industry, what is another term for "fee"?
All rights reserved © 2025/ 2026 |
, Page |4
Ans: Charge
What is the purpose of a random audit of coded data? Select all that
apply.
Ans: Quality monitoring
Which of the following entities does not perform improper payment
reviews for CMS?
Ans: None of the above
QIO
CERT
RACs
MACs
Which of the following payment methods are global?
Ans: Correct All of the above
Answers:
All rights reserved © 2025/ 2026 |
