Certified Revenue Cycle Representative (CRCR) Practice Exam

Which entities can be classified as a health plan?

1. Only governmental organizations

2. Research institutions providing healthcare

3. Insurance companies delivering healthcare services

4. Community clinics offering medical services

The correct answer is: Insurance companies delivering healthcare services

Insurance companies delivering healthcare services are classified as health plans because they are entities that provide coverage for healthcare costs. These companies create insurance products that help policyholders manage the expenses associated with medical care, including hospital stays, physician visits, and preventive services. Health plans are responsible for determining the benefits offered, managing claims, and ensuring that policyholders receive the healthcare services they are entitled to under their coverage agreements. The other entities, while involved in various aspects of healthcare, do not fit the definition of a health plan. Governmental organizations may provide health services or programs, but not all governmental entities operate as insurance providers. Research institutions focus more on clinical trials and studies rather than offering health insurance. Community clinics provide medical services directly to patients but do not typically operate as health insurance providers; their function is to deliver care rather than manage health plan coverage. Therefore, the classification of health plans is specifically associated with companies that create and manage healthcare coverage.