D053 - Module 15 quiz
Healthcare Reimbursement Systems Quiz
Test your knowledge of the healthcare reimbursement landscape with our comprehensive quiz! This quiz covers Medicare, Medicaid, private insurance, and payment systems. It's designed to help you understand key concepts and improve your expertise in healthcare reimbursement.
- Multiple-choice questions
- Focus on reimbursement systems
- Assess your understanding of healthcare policies
Healthcare reimbursement systems have multiple steps. Which is NOT one of these steps?
Healthcare providers provide services to patient and document details
The healthcare provider assigns medical codes using an electronic database to enter a description of the patient's services, diagnosis, and treatment
The healthcare provider submits an electronic claim to a clearinghouse for review and payment
The claim is reviewed and reimbursement is usually often delayed or denied requiring an explanation of medical necessity and resubmission
Medicare and Medicaid are the largest individual health insurance programs and provide most of the insurance coverage in the United States
True
False
Which is a correct statement regarding Prospective Payments?
Cost-based reimbursement
Charge based reimbursement
Reimbursement is paid as a set percentage rate
Negotiated/established prior to provision of service
The Social Security Amendment passed in 1983 established Medicare payments to hospitals based the cost (charge) reimbursement using the national DRG system
True
False
Which statements are true regarding Diagnostic Related Groups (DRGs)?
Use major diagnostic categories
Standardize length of stay and expenses
Resulted in a unbundled payment rather than a bill for service
Goal was to monitor quality of care and utilization of services
A, B, D
All of the above
A healthcare coordinator in a community clinic is coordinating treatment for a patient who needs an MRI of their right knee. The patient has a private insurance policy. How can the care coordinator comply with private insurance regulations to ensure reimbursement for the procedure?
Have the patient confirm coverage with the insurance company
Confirm that the patient does not also qualify for Medicare or Medicaid
Let the patient know that the procedure most likely will not be covered by the insurance company
Submit a pre-authorization for the MRI
Both D and D
Reimbursement within the private healthcare system is very similar to the Medicare and Medicaid program
True
False
Which statement is true regarding Healthcare reimbursement?
Private insurance companies use the same diagnosis coding system as Medicare and Medicaid but have their own billing system
Medicare, Medicaid, and private insurers can not choose the care services that they will reimburse
Private insurers often use Medicare's reimbursement rates as baselines for their own reimbursement schedules
The federal but not state governments may sometimes mandate that certain care services be covered by private insurers
The Department of Health and Human Services and the Office of the Inspector General (OIG) help protect against fraud
True
False
Which statements are correct regarding Retrospective Payments? SELECT ALL THAT APPLY
Charge based reimbursement
Cost-Based reimbursement
Made hospital acquired conditions not reimbursable
Reimbursement paid at a set percentage rate
All of the above
Which statement is true regarding private insurers and their regulation?
Are private not-for-profit so are not regulated by either the federal or state governments
Are required to have a provider appeal process for care services that have been denied
Cannot be required to cover specific care services
Are subject to the medical loss ratio with reimbursement for patient care services
Both B and D
All of the above
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