HEALTHCARE REIMBURSEMENT
FINAL EXAM QUESTIONS AND
ANSWERS (VERIFIED AND UPDATED)
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
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
@2026/2027 ALLRIGHTS RESERVED.
,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
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"? - 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
@2026/2027 ALLRIGHTS RESERVED.
, CERT
RACs
MACs
Which of the following payment methods are global? - ANS Correct All of the above
Answers:
Block grants
Surgical packages
Bundling
Correct All of the above
Which of the following is an example of fraud? - ANS Billing for a service not furnished as
represented on the claim
Which patient registration error can appropriately be corrected by HIM coders, if permitted by
policy and procedures? - ANS Admission date
Which is an example of a practice that will most likely result in late charges? - ANS Due to low
volume, radiation oncology collects their charges and posts once a week.
True or False? The constant trend of increased national spending on healthcare is a concern
because as spending on healthcare increases, the money available for other sectors of the
economy decreases. - ANS True
@2026/2027 ALLRIGHTS RESERVED.
FINAL EXAM QUESTIONS AND
ANSWERS (VERIFIED AND UPDATED)
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
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
@2026/2027 ALLRIGHTS RESERVED.
,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
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"? - 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
@2026/2027 ALLRIGHTS RESERVED.
, CERT
RACs
MACs
Which of the following payment methods are global? - ANS Correct All of the above
Answers:
Block grants
Surgical packages
Bundling
Correct All of the above
Which of the following is an example of fraud? - ANS Billing for a service not furnished as
represented on the claim
Which patient registration error can appropriately be corrected by HIM coders, if permitted by
policy and procedures? - ANS Admission date
Which is an example of a practice that will most likely result in late charges? - ANS Due to low
volume, radiation oncology collects their charges and posts once a week.
True or False? The constant trend of increased national spending on healthcare is a concern
because as spending on healthcare increases, the money available for other sectors of the
economy decreases. - ANS True
@2026/2027 ALLRIGHTS RESERVED.
