1
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Healthcare Reimbursement Final Exam
Newest 2025/2026 Complete Questions
and Answers (100% Correct Answers)
Already Graded A+
There are 3 parties in healthcare reimbursement. Who is the first
party? [ ANS: ] Patient or guarantor
Which type of reimbursement methodology is associated with the
abbreviation "PMPM"? [ ANS: ] Capitated payment
© 2025 Assignment Expert
What is an example of a charge that usually would be reviewed
by an HIM coder? [ ANS: ] Claim is failing due to potentially
incomplete code, including missing modifiers.
Guru01 - Stuvia
Which of the following coding systems was created for reporting
procedures and services performed by physicians in clinical
practice? [ ANS: ] CPT
What impact does a hospital acquired condition have on a
hospital's Medicare reimbursement? [ ANS: ] 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? [
ANS: ] Usual Customary and Reasonable
Which statement describes the per diem payment method? [
ANS: ] Fixed rate for each day a covered member is hospitalized
Which discounted fee-for-service healthcare payment method
does Medicare use to reimburse physicians? [ ANS: ] RBRVS
Which type of RAC review combines data analysis and submission
of medical records to the RAC? [ ANS: ] Semi-automated
, 2
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In the healthcare industry, what is the term for receiving
compensation for healthcare services that were previously
provided? [ ANS: ] Reimbursement
To which of the following factors is health insurance status most
closely linked? [ ANS: ] Employment
What is the optimum chart completion window for revenue cycle
purposes? [ ANS: ] Within the bill hold period
Which of the following is the correct format for HCPCS Level II
codes? [ ANS: ] A1234
© 2025 Assignment Expert
In the United States, what is healthcare insurance? [ ANS: ]
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
Guru01 - Stuvia
In the healthcare industry, what is another term for "fee"? [ ANS: ]
Charge
What is the purpose of a random audit of coded data? Select all
that apply. [ ANS: ] Quality monitoring
Which of the following entities does not perform improper
payment reviews for CMS? [ ANS: ] None of the above
QIO
CERT
RACs
MACs
, 3
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Which of the following payment methods are global? [ ANS: ]
Correct All of the above
Answers:
Block grants
Surgical packages
Bundling
© 2025 Assignment Expert
Correct All of the above
Guru01 - Stuvia
Which of the following is an example of fraud? [ ANS: ] Billing for a
service not furnished as represented on the claim
Which patient registration error can appropriately be corrected
by HIM coders, if permitted by policy and procedures? [ ANS: ]
Admission date
Which is an example of a practice that will most likely result in late
charges? [ ANS: ] 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. [ ANS: ] 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? [ ANS: ] Targeted review
For Expert help and assignment solutions, +254707240657
Healthcare Reimbursement Final Exam
Newest 2025/2026 Complete Questions
and Answers (100% Correct Answers)
Already Graded A+
There are 3 parties in healthcare reimbursement. Who is the first
party? [ ANS: ] Patient or guarantor
Which type of reimbursement methodology is associated with the
abbreviation "PMPM"? [ ANS: ] Capitated payment
© 2025 Assignment Expert
What is an example of a charge that usually would be reviewed
by an HIM coder? [ ANS: ] Claim is failing due to potentially
incomplete code, including missing modifiers.
Guru01 - Stuvia
Which of the following coding systems was created for reporting
procedures and services performed by physicians in clinical
practice? [ ANS: ] CPT
What impact does a hospital acquired condition have on a
hospital's Medicare reimbursement? [ ANS: ] 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? [
ANS: ] Usual Customary and Reasonable
Which statement describes the per diem payment method? [
ANS: ] Fixed rate for each day a covered member is hospitalized
Which discounted fee-for-service healthcare payment method
does Medicare use to reimburse physicians? [ ANS: ] RBRVS
Which type of RAC review combines data analysis and submission
of medical records to the RAC? [ ANS: ] Semi-automated
, 2
For Expert help and assignment solutions, +254707240657
In the healthcare industry, what is the term for receiving
compensation for healthcare services that were previously
provided? [ ANS: ] Reimbursement
To which of the following factors is health insurance status most
closely linked? [ ANS: ] Employment
What is the optimum chart completion window for revenue cycle
purposes? [ ANS: ] Within the bill hold period
Which of the following is the correct format for HCPCS Level II
codes? [ ANS: ] A1234
© 2025 Assignment Expert
In the United States, what is healthcare insurance? [ ANS: ]
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
Guru01 - Stuvia
In the healthcare industry, what is another term for "fee"? [ ANS: ]
Charge
What is the purpose of a random audit of coded data? Select all
that apply. [ ANS: ] Quality monitoring
Which of the following entities does not perform improper
payment reviews for CMS? [ ANS: ] None of the above
QIO
CERT
RACs
MACs
, 3
For Expert help and assignment solutions, +254707240657
Which of the following payment methods are global? [ ANS: ]
Correct All of the above
Answers:
Block grants
Surgical packages
Bundling
© 2025 Assignment Expert
Correct All of the above
Guru01 - Stuvia
Which of the following is an example of fraud? [ ANS: ] Billing for a
service not furnished as represented on the claim
Which patient registration error can appropriately be corrected
by HIM coders, if permitted by policy and procedures? [ ANS: ]
Admission date
Which is an example of a practice that will most likely result in late
charges? [ ANS: ] 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. [ ANS: ] 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? [ ANS: ] Targeted review
