WGU C812 HIM 4610 Healthcare Reimbursement Final Exam Review Q & A 2026 (Complete And Verified Study material) (23pages) LEARNEXAMS

1. What is the primary purpose of the Resource-Based Relative Value Scale (RBRVS)? A) To determine how much Medicare pays for each service B) To regulate the cost of healthcare services nationwide C) To provide patients with an estimate of healthcare costs D) To assess the quality of care provided by healthcare facilities Answer: A) The RBRVS is used by Medicare to determine how much it pays for each service, based on the resource costs needed to provide them. 2. Which of the following best describes a capitation payment model? A) A fixed amount per patient regardless of the number of services provided B) Payment based on the actual services provided to patients C) A retrospective payment system based on costs incurred D) Payment for performance based on quality and efficiency Answer: A) Capitation payment model involves a fixed amount per patient regardless of the number of services provided. 3. What is the significance of Diagnosis-Related Groups (DRGs) in healthcare reimbursement? A) They determine the reimbursement rate for inpatient hospital services B) They are used to classify outpatient services C) They provide a framework for preventive care services D) They are used to evaluate the performance of healthcare providers Answer: A) DRGs determine the reimbursement rate for inpatient hospital services by classifying them into groups based on similar clinical characteristics and resource usage. Which of the following best describes the term "fee-for-service" in healthcare reimbursement? A. A fixed payment made by insurance companies to healthcare providers. B. Payment based on the number of services provided to patients. C. A lump sum paid by patients for all healthcare services. D. Payment made only for consultation services. Answer: B. Payment based on the number of services provided to