HIM 2430 - Healthcare Reimbursement, Insurance, Revenue Cycle Management
(RCM), Medicare Parts A B C D, Medicaid, TRICARE, CHIP, PPO HMO POS Plans,
Capitation, Prospective vs Retrospective Payment Systems, MS-DRG, APC, IPPS,
HOPPS, SNF PPS, IRF PPS, LTCH, Home Health PPS, Case Mix Index, Utilization
Review, Medical Necessity, Coding Compliance, ICD-10-CM, CPT, HCPCS Level II,
Fraud and Abuse, RAC Audits, EOB, Remittance Advice, Premiums, Deductibles,
Coinsurance, Copayments, Risk Pooling, Contractual Allowances, Charge Master
(CDM), Accounts Receivable, Value-Based Purchasing (VBP), Pay-for-
Performance (P4P), Hospital Acquired Conditions, Managed Care Models, ACA,
ARRA, HITECH, Healthcare Delivery Systems, Allied Health Roles, Clinical
Privileges, Continuum of Care Comprehensive Exam Questions Verified and
Provided with Complete A+ Graded Rationales Latest Updated 2026
True or False: A group of insureds with similar risks or loss is known as a risk pool.
True
Reimbursement for healthcare depends on patients having _______?
health insurance
True or false: The premiums received by the insurance company do not offset the loss the
insurance company assumes.
False. Insurance premiums do offset the loss the insurance company assumes.
,True or false: Health insurance became established in 1929 when Blue Cross covered
schoolteachers in Texas.
True
In which type of payment method does the payer learn of the costs for health services after the
services are performed?
a. prospective payment system
b. retrospective payment system
c. APC
d. RVRBS
b. retrospective payment system
True or false: Dependent coverage is for spouses and children.
True
True or false: Health insurance that covers only the employee is known as individual coverage.
True
Episode-of-care and Fee-for-service reimbursements are ____types of unit of payments.
a. major
,b. minor
c. retrospective
a. major
In Prospective payment method the payment is ____ before the services are rendered.
a. preset
b. not determined
a. preset
When was the Medicare pharmacy benefit plan (e.g., Medicare Part D) implemented ?
2006
The coding system that is used primarily for reporting diagnoses for hospital inpatients is known
as:
a. CPT
b. ICD-10-CM
c. ICD-10-PCS
d. HCPCS Level II
b. ICD-10-CM
, Which of the following coding systems was created for reporting procedures and services
performed by physicians in clinical practice?
a. ICD-9-CM
b. CPT
c. ICD-10-PCS
d. HCPCS Level II
b. CPT
Under MSDRGs, all of the following factors influence a facility's case mix index, except:
a. The productivity standard for coders
b. Changes in services offered by the facility
c. Changes made by CMS to MS-DRG relative weights
d. Accuracy of documentation and coding
a. The productivity standard for coders
Which of the following is not a reason to perform case-mix
analysis?
a. Analyze reimbursement fluctuations
b. Determine the correct MS-DRG assignment for an
encounter
c. Describe a population to be served
(RCM), Medicare Parts A B C D, Medicaid, TRICARE, CHIP, PPO HMO POS Plans,
Capitation, Prospective vs Retrospective Payment Systems, MS-DRG, APC, IPPS,
HOPPS, SNF PPS, IRF PPS, LTCH, Home Health PPS, Case Mix Index, Utilization
Review, Medical Necessity, Coding Compliance, ICD-10-CM, CPT, HCPCS Level II,
Fraud and Abuse, RAC Audits, EOB, Remittance Advice, Premiums, Deductibles,
Coinsurance, Copayments, Risk Pooling, Contractual Allowances, Charge Master
(CDM), Accounts Receivable, Value-Based Purchasing (VBP), Pay-for-
Performance (P4P), Hospital Acquired Conditions, Managed Care Models, ACA,
ARRA, HITECH, Healthcare Delivery Systems, Allied Health Roles, Clinical
Privileges, Continuum of Care Comprehensive Exam Questions Verified and
Provided with Complete A+ Graded Rationales Latest Updated 2026
True or False: A group of insureds with similar risks or loss is known as a risk pool.
True
Reimbursement for healthcare depends on patients having _______?
health insurance
True or false: The premiums received by the insurance company do not offset the loss the
insurance company assumes.
False. Insurance premiums do offset the loss the insurance company assumes.
,True or false: Health insurance became established in 1929 when Blue Cross covered
schoolteachers in Texas.
True
In which type of payment method does the payer learn of the costs for health services after the
services are performed?
a. prospective payment system
b. retrospective payment system
c. APC
d. RVRBS
b. retrospective payment system
True or false: Dependent coverage is for spouses and children.
True
True or false: Health insurance that covers only the employee is known as individual coverage.
True
Episode-of-care and Fee-for-service reimbursements are ____types of unit of payments.
a. major
,b. minor
c. retrospective
a. major
In Prospective payment method the payment is ____ before the services are rendered.
a. preset
b. not determined
a. preset
When was the Medicare pharmacy benefit plan (e.g., Medicare Part D) implemented ?
2006
The coding system that is used primarily for reporting diagnoses for hospital inpatients is known
as:
a. CPT
b. ICD-10-CM
c. ICD-10-PCS
d. HCPCS Level II
b. ICD-10-CM
, Which of the following coding systems was created for reporting procedures and services
performed by physicians in clinical practice?
a. ICD-9-CM
b. CPT
c. ICD-10-PCS
d. HCPCS Level II
b. CPT
Under MSDRGs, all of the following factors influence a facility's case mix index, except:
a. The productivity standard for coders
b. Changes in services offered by the facility
c. Changes made by CMS to MS-DRG relative weights
d. Accuracy of documentation and coding
a. The productivity standard for coders
Which of the following is not a reason to perform case-mix
analysis?
a. Analyze reimbursement fluctuations
b. Determine the correct MS-DRG assignment for an
encounter
c. Describe a population to be served
