HIT 235 FINAL EXAM QUESTIONS WITH VERIFIED SOLUTIONS LATEST UPDATE 2026
Which of the following is part of the physical safeguards identified under the HIPAA Security Rule that
helps to protect health information? - Answers Workstation and security devices
Which type of information can a patient find on their Explanation of Benefits? - Answers How much
of the plan deductible has been met.
What is used by a third-party payer of a claim to inform a service provider with information on what
has been paid and why? - Answers Remittance advice
What is used to protect how personal health information is transmitted or maintained by electronic
media? - Answers HIPAA Security Rule
How does HIPAA apply to the revenue cycle? - Answers It protects patient information.
If a provider is a non-participating provider for Medicare, how does a limiting charge impact them? -
Answers It reduces the amount of the allowable charge by 5 percent.
When the Centers for Medicare and Medicaid Services (CMS) makes a payment using the Prospective
Payment System, what is the Medicare payment based on? - Answers A predetermined, fixed amount
When using a Prospective Payment System, how is the payment for a service determined? - Answers
Based on the classification system of that service
How is the Medicare Physician Fee Schedule used? - Answers To reimburse for services covered
under Medicare Part B
Where would a health care provider find information on adjustments made by Medicare, secondary
health plans, and expected copays and coinsurance of a patient? - Answers In the remittance advice
The Case Mix Group (CMG) classification is used to determine the payment rate per stay under the
Medicare Prospective Payment System (PPS) for which type of inpatient facility? - Answers
Rehabilitation
Which of the following is the standardized coding system used to identify procedures and submit
claims to Medicare? - Answers HCPCS
What is the potential consequence of an incorrect APC? - Answers The prospective payment will be
incorrect.
How are ambulatory surgical center payment rates determined? - Answers At 80% after adjustment
for regional variations
How does Pay-for-Performance disrupt the traditional fee-for-service model? - Answers Hospitals are
required to focus on factors unrelated to a fee-for-service system.
Which Merit-based Incentive Payment System performance category is concerned with the
promotion of patient engagement and the use of electronic health records for the exchange of
information? - Answers Promoting interoperability
Which of the following accurately describes the Hierarchical Condition Category (HCC) coding
payment model? - Answers Risk-adjustment prediction model used to reimburse Medicare
Advantage plans based on diagnosis codes in risk categories founded on patient health conditions and
long-term health care cost impact
Consider the POA (Present on Admission) reporting options below. Determine when the "U" indicator
would be appropriate to assign to the principal diagnosis, secondary diagnosis, or external cause of
injury code. Which of these is correct? - Answers Documentation insufficient to determine if the
condition is present on admission
How can physician offices use practice management software systems to improve the revenue cycle? -
Answers To have fewer rejections of payments
How are zero volume charges in clinical departments avoided? - Answers Remove the item from the
CDM
How often are HCPCS level II codes updated? - Answers Quarterly
What makes the Chargemaster a vital component of the revenue cycle? - Answers It lists all items
that can be charged to patients' accounts.
When considering documentation provided in a patient portal, which of the following would be
administrative data? - Answers Advanced directives
In the inpatient setting, what would a Clinical Documentation Integrity (CDI) specialist typically focus
on? - Answers Concurrent reviews
Which of the following involves a clinical review of a case to identify gaps between what is
documented and the clinical evidence offered? - Answers Clinical validation
Which of the following is part of the physical safeguards identified under the HIPAA Security Rule that
helps to protect health information? - Answers Workstation and security devices
Which type of information can a patient find on their Explanation of Benefits? - Answers How much
of the plan deductible has been met.
What is used by a third-party payer of a claim to inform a service provider with information on what
has been paid and why? - Answers Remittance advice
What is used to protect how personal health information is transmitted or maintained by electronic
media? - Answers HIPAA Security Rule
How does HIPAA apply to the revenue cycle? - Answers It protects patient information.
If a provider is a non-participating provider for Medicare, how does a limiting charge impact them? -
Answers It reduces the amount of the allowable charge by 5 percent.
When the Centers for Medicare and Medicaid Services (CMS) makes a payment using the Prospective
Payment System, what is the Medicare payment based on? - Answers A predetermined, fixed amount
When using a Prospective Payment System, how is the payment for a service determined? - Answers
Based on the classification system of that service
How is the Medicare Physician Fee Schedule used? - Answers To reimburse for services covered
under Medicare Part B
Where would a health care provider find information on adjustments made by Medicare, secondary
health plans, and expected copays and coinsurance of a patient? - Answers In the remittance advice
The Case Mix Group (CMG) classification is used to determine the payment rate per stay under the
Medicare Prospective Payment System (PPS) for which type of inpatient facility? - Answers
Rehabilitation
Which of the following is the standardized coding system used to identify procedures and submit
claims to Medicare? - Answers HCPCS
What is the potential consequence of an incorrect APC? - Answers The prospective payment will be
incorrect.
How are ambulatory surgical center payment rates determined? - Answers At 80% after adjustment
for regional variations
How does Pay-for-Performance disrupt the traditional fee-for-service model? - Answers Hospitals are
required to focus on factors unrelated to a fee-for-service system.
Which Merit-based Incentive Payment System performance category is concerned with the
promotion of patient engagement and the use of electronic health records for the exchange of
information? - Answers Promoting interoperability
Which of the following accurately describes the Hierarchical Condition Category (HCC) coding
payment model? - Answers Risk-adjustment prediction model used to reimburse Medicare
Advantage plans based on diagnosis codes in risk categories founded on patient health conditions and
long-term health care cost impact
Consider the POA (Present on Admission) reporting options below. Determine when the "U" indicator
would be appropriate to assign to the principal diagnosis, secondary diagnosis, or external cause of
injury code. Which of these is correct? - Answers Documentation insufficient to determine if the
condition is present on admission
How can physician offices use practice management software systems to improve the revenue cycle? -
Answers To have fewer rejections of payments
How are zero volume charges in clinical departments avoided? - Answers Remove the item from the
CDM
How often are HCPCS level II codes updated? - Answers Quarterly
What makes the Chargemaster a vital component of the revenue cycle? - Answers It lists all items
that can be charged to patients' accounts.
When considering documentation provided in a patient portal, which of the following would be
administrative data? - Answers Advanced directives
In the inpatient setting, what would a Clinical Documentation Integrity (CDI) specialist typically focus
on? - Answers Concurrent reviews
Which of the following involves a clinical review of a case to identify gaps between what is
documented and the clinical evidence offered? - Answers Clinical validation
