<div><span style="font-size: 14pt;"><strong>D053 - Module 15 quiz</strong></span></div>

Create an informative and engaging illustration depicting various healthcare reimbursement processes, including Medicare, Medicaid, and private insurance payment systems, featuring healthcare professionals and patients in a clinical setting.

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

11 Questions3 MinutesCreated by AssessingData23

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

D053 - Module 15 quiz

Healthcare Reimbursement Systems Quiz

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