1|Page
COMPREHENSIVE TEST- PRINCIPALS OF
HEALTHCARE REIMBURSEMENT AND REVENUE
CYCLE MANAGEMENT REVIEW 2025| BRAND NEW
ACTUAL EXAM WITH 100% VERIFIED QUESTIONS
AND CORRECT SOLUTIONS| GUARANTEED VALUE
PACK| ACE YOUR GRADES
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. - (answer)increased
The goal of revenue integrity is to produce a claim that is __________. -
(answer)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 ________.
- (answer)Provider; third-party payer
In the US, what is health insurance? - (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
An employee paying for 40 percent of the insurance premium through payroll
processing is an example of a transaction between ________ and ________. -
(answer)Patient; employer
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Which of the following is not a principle of revenue integrity? - (answer)No
oversight
In this healthcare delivery model, the insurance company determines that
contribution amount that is not based on the policyholder's income: -
(answer)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: - (answer)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: -
(answer)Social insurance model
Which of the following is a key factor in establishing a highly ethical culture that
promotes honesty and openness? - (answer)Transparency
Which of the following types of care represent healthcare services not delivered
by MCOs? - (answer)Experimental devices
What is the term that means evaluating, for a healthcare service, the
appropriateness of its setting and its level of service? - (answer)Utilization review
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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? -
(answer)Risk pool
All of the following activities are steps in medical necessity and utilization review
except: - (answer)Administrative review
All of the following functions are ways that MCOs work toward their goal of
controlling cost except: - (answer)Use of evidence based clinical practice
guidelines
Medicare has four criteria to define medically necessary services. Which of the
following is not one of the four criteria? - (answer)Considered to be good medical
practice by the physician providing the service
Once the maximum out-of-pocket benefit is activated, all covered healthcare
services for that policyholder or beneficiary are paid at 100 percent by the health
insurance plan. The policyholder is not liable for _________ beyond the maximum
out-of-pocket amount. - (answer)Cost sharing amounts
Managed care plans control beneficiary choice of provider. On the continuum of
control, which type of managed care organization has the most control and,
therefore, has the greatest limitations on a beneficiary seeing a provider that is
not in-network? - (answer)Health maintenance organization
COMPREHENSIVE TEST- PRINCIPALS OF
HEALTHCARE REIMBURSEMENT AND REVENUE
CYCLE MANAGEMENT REVIEW 2025| BRAND NEW
ACTUAL EXAM WITH 100% VERIFIED QUESTIONS
AND CORRECT SOLUTIONS| GUARANTEED VALUE
PACK| ACE YOUR GRADES
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. - (answer)increased
The goal of revenue integrity is to produce a claim that is __________. -
(answer)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 ________.
- (answer)Provider; third-party payer
In the US, what is health insurance? - (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
An employee paying for 40 percent of the insurance premium through payroll
processing is an example of a transaction between ________ and ________. -
(answer)Patient; employer
,2|Page
Which of the following is not a principle of revenue integrity? - (answer)No
oversight
In this healthcare delivery model, the insurance company determines that
contribution amount that is not based on the policyholder's income: -
(answer)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: - (answer)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: -
(answer)Social insurance model
Which of the following is a key factor in establishing a highly ethical culture that
promotes honesty and openness? - (answer)Transparency
Which of the following types of care represent healthcare services not delivered
by MCOs? - (answer)Experimental devices
What is the term that means evaluating, for a healthcare service, the
appropriateness of its setting and its level of service? - (answer)Utilization review
, 3|Page
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? -
(answer)Risk pool
All of the following activities are steps in medical necessity and utilization review
except: - (answer)Administrative review
All of the following functions are ways that MCOs work toward their goal of
controlling cost except: - (answer)Use of evidence based clinical practice
guidelines
Medicare has four criteria to define medically necessary services. Which of the
following is not one of the four criteria? - (answer)Considered to be good medical
practice by the physician providing the service
Once the maximum out-of-pocket benefit is activated, all covered healthcare
services for that policyholder or beneficiary are paid at 100 percent by the health
insurance plan. The policyholder is not liable for _________ beyond the maximum
out-of-pocket amount. - (answer)Cost sharing amounts
Managed care plans control beneficiary choice of provider. On the continuum of
control, which type of managed care organization has the most control and,
therefore, has the greatest limitations on a beneficiary seeing a provider that is
not in-network? - (answer)Health maintenance organization
