Healthcare Reimbursement Final Exam Fall 2023 with verified solutions

Healthcare Reimbursement Final Exam Fall 2023 with verified solutions There are 3 parties in healthcare reimbursement. Who is the first party? Patient or guarantor Which type of reimbursement methodology is associated with the abbreviation "PMPM"? Capitated payment What is an example of a charge that usually would be reviewed by an HIM coder? Claim is failing due to potentially incomplete code, including missing modifiers. Which of the following coding systems was created for reporting procedures and services performed by physicians in clinical practice? CPT What impact does a hospital acquired condition have on a hospital's Medicare reimbursement? 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? Usual Customary and Reasonable Which statement describes the per diem payment method? Fixed rate for each day a covered member is hospitalized Which discounted fee-for-service healthcare payment method does Medicare use to reimburse physicians? RBRVS Which type of RAC review combines data analysis and submission of medical records to the RAC? Semi-automated In the healthcare industry, what is the term for receiving compensation for healthcare services that were previously provided? Reimbursement To which of the following factors is health insurance status most closely linked? Employment What is the optimum chart completion window for revenue cycle purposes? Within the bill hold period Which of the following is the correct format for HCPCS Level II codes? A1234 In the United States, what is healthcare insurance? 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 In the healthcare industry, what is another term for "fee"? Charge What is the purpose of a random audit of coded data? Select all that apply. Quality monitoring Which of the following entities does not perform improper payment reviews for CMS? None of the above QIO