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Registered Health Information Administrator (RHIA) Questions 406–410 (page: 83)

Updated On: 9-Feb-2026

If a participating provider's usual fee for a service is $700.00 and Medicare's allowed amount is $450.00, what amount is written off by the physician?

  1. none of it is written off.
  2. $250.00
  3. $450.00
  4. $391.00

Answer(s): B



Health plans that use _________ reimbursement methods issue lump-sum payments to providers to compensate them for all the health care services delivered to a patient fro a specific illness and/or over a specific period of time.

  1. episode-of-care (EOC)
  2. capitation
  3. fee-for-service
  4. bundled

Answer(s): A



Fee schedules are updated by third party payers

  1. monthly
  2. weekly
  3. annually
  4. semiannually

Answer(s): C



Commercial insurance plans usually reimburse health care providers under some type of __________ payment system, whereas the federal Medicare program uses some type of ___________ payment system.

  1. prospective, retrospective
  2. retrospective, concurrent
  3. retrospective, prospective
  4. prospective, concurrent

Answer(s): C



The difference between a rejected claim and a denied claim is that

  1. a rejected claim is sent back to the provider; errors may be corrected and the claim resubmitted.
  2. a denied claim is sent back to the provider; errors may be corrected and the claim resubmitted.
  3. a rejected claim may be appealed, but a denied claim may not be appealed.
  4. if a procedure or service is unauthorized, the claim will be rejected, not denied.

Answer(s): A



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