HIM 400 Exam #1 - Class Review Exam Questions and Answers
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Course
FAML 400
Institution
FAML 400
Individual who purchases health insurance coverage - Answer-Policyholder
Group of individuals or entities who have a similar risk of loss - Answer-Risk pool
Insurance company or health agency that pays the provider for the care or services provided to the patient - Answer-Third-party payer
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HIM 400 Exam #1 - Class Review Exam
Questions and Answers
Individual who purchases health insurance coverage - Answer-Policyholder
Group of individuals or entities who have a similar risk of loss - Answer-Risk pool
Insurance company or health agency that pays the provider for the care or services
provided to the patient - Answer-Third-party payer
An individual who is eligible for benefits from a health plan - Answer-Beneficiary
Person who is responsible for paying the bill for healthcare services - Answer-Guarantor
Amount of money that must be periodically paid to a health insurance company in return
for healthcare coverage. - Answer-Premium
Reduction of a person's exposure to risk of loss by having another party assume the risk
- Answer-Insurance
The amount paid to a healthcare provider for services provided to a patient. - Answer-
Reimbursement
- Completing one's assigned revenue cycle tasks by following the provided procedure
and following all rules.
- Speaking up if the procedure is not working or is causing extra steps or rework.
- Speaking up if others are not following the rules. - Answer-Revenue integrity
A process of completing all the steps that the facility or provider must take to ask for
reimbursement from the payer and to ensure that the received payment is correct. -
Answer-Revenue cycle
- Combining the revenue cycle for different types of services into one process.
- This becomes complicated when there are multiple payment systems involved. But
there are benefits to implementation of this concept including reducing cost, making
procedures consistent and focusing on strategic goals that benefit the organization. -
Answer-Integrated revenue cycle
Medicare Advantage managed care plan - Answer-Medicare Part C
Medicare supplemental insurance - Answer-Medigap
, Ensures that civilian employees of the federal government are provided medical, death,
and income benefits for work-related injuries and illnesses - Answer-Federal
Employees' Compensation Act of 1916
Enrollee in Medicare - Answer-Beneficiary
Insurance for acute-care hospital inpatient admissions - Answer-Medicare Part A
Medicare prescription drug benefit - Answer-Medicare Part D
Insurance for services and care provided by a physician - Answer-Medicare Part B
Law that outlines the Medicare and Medicaid programs - Answer-Social Security Act
Provides healthcare coverage to children whose parents do not qualify for Medicaid, but
are unable to afford health insurance - Answer-Children's Health Insurance Program
(CHIP)
Provides healthcare services and supplies to family members whose spouse or parent
was permanently disabled or killed during their time of service. An example of a supply
is outpatient prescription drugs. - Answer-Civilian Health and Medical Program of the
Department of Veterans Affairs (CHAMPVA)
Provides healthcare services to the members of federally recognized Native American
tribes. - Answer-Indian Health Services (IHS)
Provides services and supplies to the frail elderly population in their own communities
so they can remain living in their homes - Answer-Program of All-Inclusive Care for the
Elderly (PACE)
Provides health insurance for the military and their families - Answer-TRICARE
Provides healthcare services to veterans who served and were honorably discharged
from military service - Answer-Veterans Health Administration
Provides healthcare services and lost income to individuals who are injured at work or
acquire a work-related illness. - Answer-Workers' Compensation
Risk adjustment model that uses patient demographic characteristics and medical
conditions to predict the patient's healthcare costs. - Answer-CMS-HCC Model
Amount the provider is actually charging for a service - Answer-Billed charges
Type of risk used in ACO payment methodology where the ACO must share in the loss
if the cost of care for their attributed beneficiaries is greater than the benchmark as well
as any savings if the cost of care is lower than the benchmark. - Answer-Two-sided risk
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