#1
Which healthcare reimbursement system pays providers a fixed amount per patient regardless of the services provided?
Fee-for-Service (FFS)
Capitation
Value-Based Reimbursement
Bundled Payments
#2
Under which healthcare reimbursement model do providers receive payment for each service performed?
Capitation
Bundled Payments
Fee-for-Service (FFS)
Value-Based Reimbursement
#3
Which government program provides healthcare coverage for individuals aged 65 and older in the United States?
Medicaid
CHIP
Medicare
Tricare
#4
What is the main purpose of the Healthcare Common Procedure Coding System (HCPCS)?
Assigning diagnostic codes to diseases
Billing for healthcare services and procedures
Regulating healthcare facilities
Providing medical training to professionals
#5
What is the primary function of a Healthcare Information Management System (HIMS)?
Facilitating communication between healthcare providers and patients
Managing and storing patient health records electronically
Performing medical procedures on patients
Conducting clinical trials for new drugs
#6
Which organization is responsible for developing and maintaining the Current Procedural Terminology (CPT) codes?
World Health Organization (WHO)
American Medical Association (AMA)
Centers for Medicare & Medicaid Services (CMS)
National Institutes of Health (NIH)
#7
What is the primary goal of Value-Based Reimbursement?
Maximizing the volume of services provided
Minimizing patient outcomes
Improving the quality and efficiency of care
Limiting access to healthcare services
#8
Which of the following is NOT a factor considered in a Diagnosis-Related Group (DRG) payment system?
Patient demographics
Diagnosis
Procedures performed
Length of hospital stay
#9
Which organization oversees the administration of Medicaid at the federal level?
Centers for Disease Control and Prevention (CDC)
Food and Drug Administration (FDA)
Centers for Medicare & Medicaid Services (CMS)
National Institutes of Health (NIH)
#10
What term describes a healthcare provider's ability to deliver services to patients in a timely manner?
Utilization review
Access
Quality improvement
Risk management
#11
What does the term 'balance billing' refer to in healthcare reimbursement?
Billing patients for the remaining balance after insurance payment
Ensuring equal reimbursement for all healthcare providers
Adjusting billing codes to match patient demographics
Refusing to bill insurance companies for services rendered
#12
Which type of healthcare reimbursement system incentivizes providers to achieve specific quality and cost targets?
Fee-for-Service (FFS)
Capitation
Value-Based Reimbursement
Bundled Payments
#13
In the healthcare reimbursement landscape, what does the term 'denial management' refer to?
Refusing access to healthcare services
Managing rejected claims and appealing denials
Accepting all insurance claims without review
Determining patient eligibility for reimbursement
#14
Under the Affordable Care Act (ACA), what is the purpose of the Medical Loss Ratio (MLR) provision?
To limit insurer profits and ensure a certain percentage of premiums are spent on healthcare services
To increase the affordability of insurance premiums for low-income individuals
To mandate coverage of specific medical treatments and procedures
To establish a single-payer healthcare system
#15
In healthcare reimbursement, what does the term 'adjudication' mean?
Approving insurance claims for payment
Initiating legal action against healthcare providers
Auditing patient medical records
Assigning diagnoses to patients
#16
Under Medicare Part D, which entity contracts with pharmacies to dispense prescription drugs to beneficiaries?
Medicare Administrative Contractor (MAC)
Pharmacy Benefit Manager (PBM)
Centers for Medicare & Medicaid Services (CMS)
Social Security Administration (SSA)
#17
In healthcare reimbursement, what is the purpose of a remittance advice (RA)?
To provide patients with information about their coverage
To notify providers of claim denials or payments
To track patients' medical history
To assist providers in billing insurance companies