Revenue Cycle - RHIT Exam 2023 Questions and Answers
What systems have been used to manage the costs of the Medicare and Medicaid
programs:
The Prospective Payment Systems (PPS)
Provide healthcare benefits to full-time employees of a company
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?
Major Medical Insurance
The amount an insured pays before the insurer assumes liability for any
remaining costs of the covered services is called
Deductible
Refers to the amount the insured pays as a requirement of the insurance policy
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?
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.
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?
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
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.
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
Medicare Part B
Long-term nursing care, Custodial Care, Dentures and Dental Care, Eyeglasses
and Hearing Aids are not covered by....
Medicare Part A & B
Tricare was formerly known as?
Champus
, The healthcare program for active-duty service members, National Guard and
Reserve members, retirees, their families, survivors and certain former spouses.
Tricare
What is Tricare Prime, Tricare Extra and Tricare Standard?
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.
CHAMPVA
The IHS is within what agency?
HHS
Provides healthcare services to American Indians and Alaska natives?
IHS (Indian Health Services)
What are prepaid health plans that integrate the financial and delivery aspects of
healthcare services?
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.
Managed Care Organizations
What authorized Federal grants and loans to private organizations that wished to
develop HMO's
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?
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.
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.
The National Committee for Quality Assurance
A prepaid voluntary health plan that provides healthcare services in return for the
payment of a monthly membership premium.
HMO (Health Maintenance Organization
Represents contractual agreements between healthcare providers and a self-
insured employer or a health insurance carrier?
PPO (Preferred Provider Organization)
Plans that are similar to HMO's but differ in that they can seek care from
providers outside of the network?
POS (Point of Service Plans)
A healthcare provider made up of a number of associated medical facilities that
furnish coordinated healthcare services.
IDS (Integrated Delivery System)
In this payment plan the exact amount of the payment is determined after the
service has been delivered
What systems have been used to manage the costs of the Medicare and Medicaid
programs:
The Prospective Payment Systems (PPS)
Provide healthcare benefits to full-time employees of a company
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?
Major Medical Insurance
The amount an insured pays before the insurer assumes liability for any
remaining costs of the covered services is called
Deductible
Refers to the amount the insured pays as a requirement of the insurance policy
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?
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.
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?
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
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.
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
Medicare Part B
Long-term nursing care, Custodial Care, Dentures and Dental Care, Eyeglasses
and Hearing Aids are not covered by....
Medicare Part A & B
Tricare was formerly known as?
Champus
, The healthcare program for active-duty service members, National Guard and
Reserve members, retirees, their families, survivors and certain former spouses.
Tricare
What is Tricare Prime, Tricare Extra and Tricare Standard?
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.
CHAMPVA
The IHS is within what agency?
HHS
Provides healthcare services to American Indians and Alaska natives?
IHS (Indian Health Services)
What are prepaid health plans that integrate the financial and delivery aspects of
healthcare services?
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.
Managed Care Organizations
What authorized Federal grants and loans to private organizations that wished to
develop HMO's
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?
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.
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.
The National Committee for Quality Assurance
A prepaid voluntary health plan that provides healthcare services in return for the
payment of a monthly membership premium.
HMO (Health Maintenance Organization
Represents contractual agreements between healthcare providers and a self-
insured employer or a health insurance carrier?
PPO (Preferred Provider Organization)
Plans that are similar to HMO's but differ in that they can seek care from
providers outside of the network?
POS (Point of Service Plans)
A healthcare provider made up of a number of associated medical facilities that
furnish coordinated healthcare services.
IDS (Integrated Delivery System)
In this payment plan the exact amount of the payment is determined after the
service has been delivered
