COMPREHENSIVE TEST- PRINCIPALS
OF HEALTHCARE REIMBURSEMENT
AND REVENUE CYCLE MANAGEMENT
REVIEW. EXAM QUESTIONS AND
ANSWERS (VERIFIED AND UPDATED)
The US healthcare sector represents a significant portion of the US economy. The trend of
_________ spending on healthcare has been consistent for more than a decade. -
ANS increased
The goal of revenue integrity is to produce a claim that is __________. - ANS Clean,
complete, and compliant
A physician office submitting an invoice (claim) for payment when the patient has health
insurance is an example of a transaction between ________ and ________. - ANS Provider;
third-party payer
In the US, what is health 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
An employee paying for 40 percent of the insurance premium through payroll processing is an
example of a transaction between ________ and ________. - ANS Patient; employer
Which of the following is not a principle of revenue integrity? - ANS No oversight
@2026/2027 ALLRIGHTS RESERVED.
, In this healthcare delivery model, the insurance company determines that contribution amount
that is not based on the policyholder's income: - ANS Private health insurance model
Successful RCM programs use this type of approach, which promotes collaboration amount
various clinical departments and emphasizes and education strategy for all members: -
ANS Multidisciplinary model
In this healthcare delivery model, employees and employers contribute an income-based
amount of money to funds that are regulated by the government: - ANS Social insurance
model
Which of the following is a key factor in establishing a highly ethical culture that promotes
honesty and openness? - ANS Transparency
Which of the following types of care represent healthcare services not delivered by MCOs? -
ANS Experimental devices
What is the term that means evaluating, for a healthcare service, the appropriateness of its
setting and its level of service? - ANS Utilization review
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? - ANS Risk pool
All of the following activities are steps in medical necessity and utilization review except: -
ANS Administrative review
All of the following functions are ways that MCOs work toward their goal of controlling cost
except: - ANS Use of evidence based clinical practice guidelines
@2026/2027 ALLRIGHTS RESERVED.
OF HEALTHCARE REIMBURSEMENT
AND REVENUE CYCLE MANAGEMENT
REVIEW. EXAM QUESTIONS AND
ANSWERS (VERIFIED AND UPDATED)
The US healthcare sector represents a significant portion of the US economy. The trend of
_________ spending on healthcare has been consistent for more than a decade. -
ANS increased
The goal of revenue integrity is to produce a claim that is __________. - ANS Clean,
complete, and compliant
A physician office submitting an invoice (claim) for payment when the patient has health
insurance is an example of a transaction between ________ and ________. - ANS Provider;
third-party payer
In the US, what is health 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
An employee paying for 40 percent of the insurance premium through payroll processing is an
example of a transaction between ________ and ________. - ANS Patient; employer
Which of the following is not a principle of revenue integrity? - ANS No oversight
@2026/2027 ALLRIGHTS RESERVED.
, In this healthcare delivery model, the insurance company determines that contribution amount
that is not based on the policyholder's income: - ANS Private health insurance model
Successful RCM programs use this type of approach, which promotes collaboration amount
various clinical departments and emphasizes and education strategy for all members: -
ANS Multidisciplinary model
In this healthcare delivery model, employees and employers contribute an income-based
amount of money to funds that are regulated by the government: - ANS Social insurance
model
Which of the following is a key factor in establishing a highly ethical culture that promotes
honesty and openness? - ANS Transparency
Which of the following types of care represent healthcare services not delivered by MCOs? -
ANS Experimental devices
What is the term that means evaluating, for a healthcare service, the appropriateness of its
setting and its level of service? - ANS Utilization review
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? - ANS Risk pool
All of the following activities are steps in medical necessity and utilization review except: -
ANS Administrative review
All of the following functions are ways that MCOs work toward their goal of controlling cost
except: - ANS Use of evidence based clinical practice guidelines
@2026/2027 ALLRIGHTS RESERVED.
