Healthcare Reimbursement Final Exam Newest
2026 Questions and Correct Detailed Answers
Already Graded A+
Which is an example of a practice that will most likely result in late charges? -
CORRECT ANSWER-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. - CORRECT ANSWER-True
You have reviewed the OIG work plan for the coming year and note several
coding issues that you want to make sure are accurately addressed by your
coders. What is your first plan of action? - CORRECT ANSWER-Targeted review
Which national model for the delivery of healthcare services is financed by
general revenue funds from taxes? - CORRECT ANSWER-National health
service (Beveridge) model
,Why do health insurers pool premium payments for all the insureds in a group
and use actuarial data to calculate the group's premiums? - CORRECT
ANSWER-To assure that the pool is large enough to pay losses of the entire
group
There are 3 parties in healthcare reimbursement. Who is the first party? -
CORRECT ANSWER-Patient or guarantor
Which type of reimbursement methodology is associated with the abbreviation
"PMPM"? - CORRECT ANSWER-Capitated payment
What is an example of a charge that usually would be reviewed by an HIM coder?
- CORRECT ANSWER-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? - CORRECT ANSWER-CPT
What impact does a hospital acquired condition have on a hospital's Medicare
reimbursement? - CORRECT ANSWER-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? - CORRECT
ANSWER-Usual Customary and Reasonable
Which statement describes the per diem payment method? - CORRECT
ANSWER-Fixed rate for each day a covered member is hospitalized
Which discounted fee-for-service healthcare payment method does Medicare use
to reimburse physicians? - CORRECT ANSWER-RBRVS
Which type of RAC review combines data analysis and submission of medical
records to the RAC? - CORRECT ANSWER-Semi-automated
In the healthcare industry, what is the term for receiving compensation for
healthcare services that were previously provided? - CORRECT ANSWER-
Reimbursement
To which of the following factors is health insurance status most closely linked? -
CORRECT ANSWER-Employment
, What is the optimum chart completion window for revenue cycle purposes? -
CORRECT ANSWER-Within the bill hold period
Which of the following is the correct format for HCPCS Level II codes? -
CORRECT ANSWER-A1234
In the United States, what is healthcare insurance? - CORRECT ANSWER-
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"? - CORRECT
ANSWER-Charge
What is the purpose of a random audit of coded data? Select all that apply. -
CORRECT ANSWER-Quality monitoring
Which of the following entities does not perform improper payment reviews for
CMS? - CORRECT ANSWER-None of the above
QIO
2026 Questions and Correct Detailed Answers
Already Graded A+
Which is an example of a practice that will most likely result in late charges? -
CORRECT ANSWER-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. - CORRECT ANSWER-True
You have reviewed the OIG work plan for the coming year and note several
coding issues that you want to make sure are accurately addressed by your
coders. What is your first plan of action? - CORRECT ANSWER-Targeted review
Which national model for the delivery of healthcare services is financed by
general revenue funds from taxes? - CORRECT ANSWER-National health
service (Beveridge) model
,Why do health insurers pool premium payments for all the insureds in a group
and use actuarial data to calculate the group's premiums? - CORRECT
ANSWER-To assure that the pool is large enough to pay losses of the entire
group
There are 3 parties in healthcare reimbursement. Who is the first party? -
CORRECT ANSWER-Patient or guarantor
Which type of reimbursement methodology is associated with the abbreviation
"PMPM"? - CORRECT ANSWER-Capitated payment
What is an example of a charge that usually would be reviewed by an HIM coder?
- CORRECT ANSWER-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? - CORRECT ANSWER-CPT
What impact does a hospital acquired condition have on a hospital's Medicare
reimbursement? - CORRECT ANSWER-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? - CORRECT
ANSWER-Usual Customary and Reasonable
Which statement describes the per diem payment method? - CORRECT
ANSWER-Fixed rate for each day a covered member is hospitalized
Which discounted fee-for-service healthcare payment method does Medicare use
to reimburse physicians? - CORRECT ANSWER-RBRVS
Which type of RAC review combines data analysis and submission of medical
records to the RAC? - CORRECT ANSWER-Semi-automated
In the healthcare industry, what is the term for receiving compensation for
healthcare services that were previously provided? - CORRECT ANSWER-
Reimbursement
To which of the following factors is health insurance status most closely linked? -
CORRECT ANSWER-Employment
, What is the optimum chart completion window for revenue cycle purposes? -
CORRECT ANSWER-Within the bill hold period
Which of the following is the correct format for HCPCS Level II codes? -
CORRECT ANSWER-A1234
In the United States, what is healthcare insurance? - CORRECT ANSWER-
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"? - CORRECT
ANSWER-Charge
What is the purpose of a random audit of coded data? Select all that apply. -
CORRECT ANSWER-Quality monitoring
Which of the following entities does not perform improper payment reviews for
CMS? - CORRECT ANSWER-None of the above
QIO
