Revenue Cycle - RHIT Exam
What systems have been used to manage the costs of the Medicare and Medicaid
programs: -ANSW- The Prospective Payment Systems (PPS)
Provide healthcare benefits to full-time employees of a company -ANSW- Group
Health Insurance
Provides benefits up to a high-dollar limit for most types of medical expenses, requires
patients to pay large deductibles, may place limits on charges and may require patients
to pay a portion of the expenses. What type of plan is this? -ANSW- Major Medical
Insurance
The amount an insured pays before the insurer assumes liability for any remaining costs
of the covered services is called -ANSW- Deductible
Refers to the amount the insured pays as a requirement of the insurance policy -
ANSW- Coinsurance
The healthcare expenses that the insured party is responsible for paying, after they
have reached the amount specified in their plan, then the plan pays 100 percent. What
is responsibility called? -ANSW- Out of pocket expenses
Is provided free of charge to individuals age 65 and over who are eligible for SS, people
under 65 with disabilities or people with end stage renal disease. Covers IP care, SNF
care, Home Healthcare and hospice. -ANSW- Medicare Part A
Is allowed under medicare if medically necessary, is limited to 90 days per benefit
period, which begins on the day of admission and ends when out of the hospital for 60
days in a row. Patient pays all deductibles and co-payments. What am I? -ANSW-
Inpatient Hospital Care
What care is covered if occurring within 30 days of a 3-day-long or longer acute
hospitalization and is medically necessary - days provided are limited to 100 per benefit
period -ANSW- Skilled Nursing Facility Care (SNF)
What care may be furnished part-time in the residence of a home-bound beneficiary
when intermittent or part-time skilled nursing, therapy or rehabilitation care is needed. -
ANSW- Home Health Care
Voluntary supplemental medical insurance helps pay for physicians services, medical
services and medical-surgical supplies not covered by hospitilization plan, over age 65,
, pay a monthly premium, must be medically necessary - deductibles and copayments -
ANSW- Medicare Part B
Long-term nursing care, Custodial Care, Dentures and Dental Care, Eyeglasses and
Hearing Aids are not covered by.... -ANSW- Medicare Part A & B
Tricare was formerly known as? -ANSW- Champus
The healthcare program for active-duty service members, National Guard and Reserve
members, retirees, their families, survivors and certain former spouses. -ANSW-
Tricare
What is Tricare Prime, Tricare Extra and Tricare Standard? -ANSW- The three types of
different plans within Tricare
A healthcare program for Dependents and survivors or permanently and totally disabled
veterans, survivors of veterans who died from service-related conditions, and survivors
of military personnel who died in the line of duty. -ANSW- CHAMPVA
The IHS is within what agency? -ANSW- HHS
Provides healthcare services to American Indians and Alaska natives? -ANSW- IHS
(Indian Health Services)
What are prepaid health plans that integrate the financial and delivery aspects of
healthcare services? -ANSW- Managed Care
Who works to control the cost of, and access to, healthcare services at the same time
that they strive to meet high-quality standards. -ANSW- Managed Care Organizations
What authorized Federal grants and loans to private organizations that wished to
develop HMO's -ANSW- Health Maintenance Organization Assistance Act
A private not-for-profit organization that accredits, assesses and reports on the quality
of managed care plans in the US is called? -ANSW- National Committee for Quality
Assurance (NCQA)
A set of standardized measures used to compare managed care plans in terms of the
quality of services they provide. Like plan membership, utilization, access to services
and financial indicators. -ANSW- HEDIS (Health Plan Employer Data and Information
Set)
Who worked with public and private healthcare purchasers, health plans, researchers
and consumer advocates to develop HEDIS. -ANSW- The National Committee for
Quality Assurance
What systems have been used to manage the costs of the Medicare and Medicaid
programs: -ANSW- The Prospective Payment Systems (PPS)
Provide healthcare benefits to full-time employees of a company -ANSW- Group
Health Insurance
Provides benefits up to a high-dollar limit for most types of medical expenses, requires
patients to pay large deductibles, may place limits on charges and may require patients
to pay a portion of the expenses. What type of plan is this? -ANSW- Major Medical
Insurance
The amount an insured pays before the insurer assumes liability for any remaining costs
of the covered services is called -ANSW- Deductible
Refers to the amount the insured pays as a requirement of the insurance policy -
ANSW- Coinsurance
The healthcare expenses that the insured party is responsible for paying, after they
have reached the amount specified in their plan, then the plan pays 100 percent. What
is responsibility called? -ANSW- Out of pocket expenses
Is provided free of charge to individuals age 65 and over who are eligible for SS, people
under 65 with disabilities or people with end stage renal disease. Covers IP care, SNF
care, Home Healthcare and hospice. -ANSW- Medicare Part A
Is allowed under medicare if medically necessary, is limited to 90 days per benefit
period, which begins on the day of admission and ends when out of the hospital for 60
days in a row. Patient pays all deductibles and co-payments. What am I? -ANSW-
Inpatient Hospital Care
What care is covered if occurring within 30 days of a 3-day-long or longer acute
hospitalization and is medically necessary - days provided are limited to 100 per benefit
period -ANSW- Skilled Nursing Facility Care (SNF)
What care may be furnished part-time in the residence of a home-bound beneficiary
when intermittent or part-time skilled nursing, therapy or rehabilitation care is needed. -
ANSW- Home Health Care
Voluntary supplemental medical insurance helps pay for physicians services, medical
services and medical-surgical supplies not covered by hospitilization plan, over age 65,
, pay a monthly premium, must be medically necessary - deductibles and copayments -
ANSW- Medicare Part B
Long-term nursing care, Custodial Care, Dentures and Dental Care, Eyeglasses and
Hearing Aids are not covered by.... -ANSW- Medicare Part A & B
Tricare was formerly known as? -ANSW- Champus
The healthcare program for active-duty service members, National Guard and Reserve
members, retirees, their families, survivors and certain former spouses. -ANSW-
Tricare
What is Tricare Prime, Tricare Extra and Tricare Standard? -ANSW- The three types of
different plans within Tricare
A healthcare program for Dependents and survivors or permanently and totally disabled
veterans, survivors of veterans who died from service-related conditions, and survivors
of military personnel who died in the line of duty. -ANSW- CHAMPVA
The IHS is within what agency? -ANSW- HHS
Provides healthcare services to American Indians and Alaska natives? -ANSW- IHS
(Indian Health Services)
What are prepaid health plans that integrate the financial and delivery aspects of
healthcare services? -ANSW- Managed Care
Who works to control the cost of, and access to, healthcare services at the same time
that they strive to meet high-quality standards. -ANSW- Managed Care Organizations
What authorized Federal grants and loans to private organizations that wished to
develop HMO's -ANSW- Health Maintenance Organization Assistance Act
A private not-for-profit organization that accredits, assesses and reports on the quality
of managed care plans in the US is called? -ANSW- National Committee for Quality
Assurance (NCQA)
A set of standardized measures used to compare managed care plans in terms of the
quality of services they provide. Like plan membership, utilization, access to services
and financial indicators. -ANSW- HEDIS (Health Plan Employer Data and Information
Set)
Who worked with public and private healthcare purchasers, health plans, researchers
and consumer advocates to develop HEDIS. -ANSW- The National Committee for
Quality Assurance
