HCR 240 FINAL EXAM (Health care
Reimbursement) LATEST 2026 UPDATE 100
QUESTIONS AND DETAILED VERIFIED ANSWERS
FROM ACTUAL EXAMS TEST GRADE A+
1. What is the primary purpose of health care reimbursement systems?
A. To reduce patient satisfaction
B. To ensure providers are compensated for services
C. To eliminate insurance companies
D. To increase hospital ownership
Answer: B. To ensure providers are compensated for services
Rationale: Reimbursement systems are designed to pay providers for healthcare
services delivered.
2. Which program provides health coverage for individuals aged 65 and older?
A. Medicaid
B. TRICARE
C. Medicare
D. CHIP
Answer: C. Medicare
Rationale: Medicare is a federal program primarily for individuals aged 65 and
older.
3. Medicaid is primarily funded by:
A. Federal government only
B. State government only
,C. Both federal and state governments
D. Private insurance companies
Answer: C. Both federal and state governments
Rationale: Medicaid is jointly funded by federal and state governments.
4. What does DRG stand for?
A. Diagnostic Related Group
B. Data Resource Group
C. Disease Risk Grade
D. Diagnosis Report Guide
Answer: A. Diagnostic Related Group
Rationale: DRGs classify hospital cases for reimbursement purposes.
5. Prospective Payment Systems (PPS) determine payment based on:
A. Actual cost after service
B. Pre-determined fixed rates
C. Patient income
D. Provider preference
Answer: B. Pre-determined fixed rates
Rationale: PPS sets payment amounts in advance based on classification systems.
6. Which part of Medicare covers hospital inpatient services?
A. Part A
B. Part B
C. Part C
D. Part D
,Answer: A. Part A
Rationale: Medicare Part A covers inpatient hospital services.
7. What is the purpose of CPT codes?
A. Classify diagnoses
B. Report medical procedures and services
C. Determine insurance eligibility
D. Track medications
Answer: B. Report medical procedures and services
Rationale: CPT codes describe procedures performed by healthcare providers.
8. ICD codes are used to:
A. Bill patients directly
B. Classify diseases and diagnoses
C. Calculate salaries
D. Schedule appointments
Answer: B. Classify diseases and diagnoses
Rationale: ICD codes standardize diagnosis classification.
9. Fee-for-service reimbursement means:
A. Fixed payment per patient
B. Payment per service provided
C. No payment required
D. Government-only funding
Answer: B. Payment per service provided
Rationale: Providers are paid for each service rendered.
, 10. Capitation payment is based on:
A. Number of services
B. Patient satisfaction
C. Fixed amount per patient
D. Length of hospital stay
Answer: C. Fixed amount per patient
Rationale: Capitation pays a set fee per enrolled patient.
11. What is a claim in healthcare reimbursement?
A. Patient complaint
B. Request for payment
C. Insurance denial
D. Legal action
Answer: B. Request for payment
Rationale: Claims are submitted to insurers for reimbursement.
12. Which entity processes Medicare claims?
A. CMS contractors
B. Hospitals
C. Patients
D. Employers
Answer: A. CMS contractors
Rationale: CMS uses contractors to process Medicare claims.
13. What does HIPAA regulate?
A. Billing rates
B. Patient privacy and data security
Reimbursement) LATEST 2026 UPDATE 100
QUESTIONS AND DETAILED VERIFIED ANSWERS
FROM ACTUAL EXAMS TEST GRADE A+
1. What is the primary purpose of health care reimbursement systems?
A. To reduce patient satisfaction
B. To ensure providers are compensated for services
C. To eliminate insurance companies
D. To increase hospital ownership
Answer: B. To ensure providers are compensated for services
Rationale: Reimbursement systems are designed to pay providers for healthcare
services delivered.
2. Which program provides health coverage for individuals aged 65 and older?
A. Medicaid
B. TRICARE
C. Medicare
D. CHIP
Answer: C. Medicare
Rationale: Medicare is a federal program primarily for individuals aged 65 and
older.
3. Medicaid is primarily funded by:
A. Federal government only
B. State government only
,C. Both federal and state governments
D. Private insurance companies
Answer: C. Both federal and state governments
Rationale: Medicaid is jointly funded by federal and state governments.
4. What does DRG stand for?
A. Diagnostic Related Group
B. Data Resource Group
C. Disease Risk Grade
D. Diagnosis Report Guide
Answer: A. Diagnostic Related Group
Rationale: DRGs classify hospital cases for reimbursement purposes.
5. Prospective Payment Systems (PPS) determine payment based on:
A. Actual cost after service
B. Pre-determined fixed rates
C. Patient income
D. Provider preference
Answer: B. Pre-determined fixed rates
Rationale: PPS sets payment amounts in advance based on classification systems.
6. Which part of Medicare covers hospital inpatient services?
A. Part A
B. Part B
C. Part C
D. Part D
,Answer: A. Part A
Rationale: Medicare Part A covers inpatient hospital services.
7. What is the purpose of CPT codes?
A. Classify diagnoses
B. Report medical procedures and services
C. Determine insurance eligibility
D. Track medications
Answer: B. Report medical procedures and services
Rationale: CPT codes describe procedures performed by healthcare providers.
8. ICD codes are used to:
A. Bill patients directly
B. Classify diseases and diagnoses
C. Calculate salaries
D. Schedule appointments
Answer: B. Classify diseases and diagnoses
Rationale: ICD codes standardize diagnosis classification.
9. Fee-for-service reimbursement means:
A. Fixed payment per patient
B. Payment per service provided
C. No payment required
D. Government-only funding
Answer: B. Payment per service provided
Rationale: Providers are paid for each service rendered.
, 10. Capitation payment is based on:
A. Number of services
B. Patient satisfaction
C. Fixed amount per patient
D. Length of hospital stay
Answer: C. Fixed amount per patient
Rationale: Capitation pays a set fee per enrolled patient.
11. What is a claim in healthcare reimbursement?
A. Patient complaint
B. Request for payment
C. Insurance denial
D. Legal action
Answer: B. Request for payment
Rationale: Claims are submitted to insurers for reimbursement.
12. Which entity processes Medicare claims?
A. CMS contractors
B. Hospitals
C. Patients
D. Employers
Answer: A. CMS contractors
Rationale: CMS uses contractors to process Medicare claims.
13. What does HIPAA regulate?
A. Billing rates
B. Patient privacy and data security
