#1
Which healthcare reimbursement system pays providers a fixed amount per patient regardless of the services provided?
Capitation
ExplanationProviders receive fixed payment per patient.
#2
Under which healthcare reimbursement model do providers receive payment for each service performed?
Fee-for-Service (FFS)
ExplanationPayment is based on services provided.
#3
Which government program provides healthcare coverage for individuals aged 65 and older in the United States?
Medicare
ExplanationProvides coverage for elderly.
#4
What is the main purpose of the Healthcare Common Procedure Coding System (HCPCS)?
Billing for healthcare services and procedures
ExplanationUsed for healthcare service billing.
#5
What is the primary function of a Healthcare Information Management System (HIMS)?
Managing and storing patient health records electronically
ExplanationManages electronic patient health records.
#6
Which organization is responsible for developing and maintaining the Current Procedural Terminology (CPT) codes?
American Medical Association (AMA)
ExplanationAMA develops and maintains CPT codes.
#7
What is the primary goal of Value-Based Reimbursement?
Improving the quality and efficiency of care
ExplanationFocuses on improving care quality and efficiency.
#8
Which of the following is NOT a factor considered in a Diagnosis-Related Group (DRG) payment system?
Patient demographics
ExplanationPatient demographics not considered in DRG payments.
#9
Which organization oversees the administration of Medicaid at the federal level?
Centers for Medicare & Medicaid Services (CMS)
ExplanationCMS oversees Medicaid.
#10
What term describes a healthcare provider's ability to deliver services to patients in a timely manner?
Access
ExplanationTimely service delivery to patients.
#11
What does the term 'balance billing' refer to in healthcare reimbursement?
Billing patients for the remaining balance after insurance payment
ExplanationBilling patients for remaining balance after insurance coverage.
#12
Which type of healthcare reimbursement system incentivizes providers to achieve specific quality and cost targets?
Value-Based Reimbursement
ExplanationIncentivizes quality and cost targets.
#13
In the healthcare reimbursement landscape, what does the term 'denial management' refer to?
Managing rejected claims and appealing denials
ExplanationHandling rejected claims and appeals.
#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
ExplanationLimits insurer profits and ensures premium allocation to healthcare services.
#15
In healthcare reimbursement, what does the term 'adjudication' mean?
Approving insurance claims for payment
ExplanationApproval of insurance claims for payment.
#16
Under Medicare Part D, which entity contracts with pharmacies to dispense prescription drugs to beneficiaries?
Pharmacy Benefit Manager (PBM)
ExplanationPBM contracts with pharmacies for drug dispensing.
#17
In healthcare reimbursement, what is the purpose of a remittance advice (RA)?
To notify providers of claim denials or payments
ExplanationNotifies providers of claim denials or payments.