HFMA ACTUAL PAPER 2026 QUESTIONS
WITH SOLUTIONS GRADED A+
◉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 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
◉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
◉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,
WITH SOLUTIONS GRADED A+
◉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 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
◉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
◉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,
