HIMS 5620 Exam 2 Questions with Correct Answers Latest Update 2026/2027
Fee Schedule - Answers Retrospective reimbursement where there is a predetermined list of
fees that the payer allows for payment for a set of healthcare services
Percent of Billed Charges - Answers Retrospective reimbursement where the payer has
negotiated to pay a reduced fee for services provided to their insureds
Per Diem - Answers Retrospective reimbursement where the payer reimburses the provider a
fixed rate for each day a covered member is hospitalized
Capitation - Answers Prospective reimbursement where the payer reimburses the provider a
fixed, per capita amount for a defined period (Per member per month)
Case Rate - Answers Prospective reimbursement where the payer reimburses the provider one
amount for the entire admission or encounter regardless of the number of services or length of
admission
Global Payment - Answers Prospective reimbursement where there is one combined payment to
cover the services of multiple providers who are treating a single episode of care (typically
physician services/outpatient care)
Bundled Payment - Answers Prospective reimbursement where there is a predetermined
payment amount provided for all services required for a single predefined episode of care.
CMS-HCC Model - Answers Risk adjustment model that uses patient demographic
characteristics and medical conditions to predict the patient's healthcare costs
Risk Adjustment - Answers Statistical process that considers the underlying health status and
health spending of patients when examining their healthcare outcomes or healthcare costs.
Risk Score - Answers Risk score of 1 represents the average Medicare beneficiary
Risk score > 1 means the beneficiary will cost more than the average Medicare beneficiary
Risk score < 1 means the beneficiary will cost less than the average Medicare beneficiary
Raw Risk Score - Answers Demographic + Coding Risk Scores
Federal Register Rule Progression - Answers Notice of Proposed Rule Making -> Comment
Period -> Final Rule
Cost Report - Answers Form that collects information about institutional providers to make
proper determinations of amounts payable under its provisions in various PPPs
Fee Schedule - Answers Retrospective reimbursement where there is a predetermined list of
fees that the payer allows for payment for a set of healthcare services
Percent of Billed Charges - Answers Retrospective reimbursement where the payer has
negotiated to pay a reduced fee for services provided to their insureds
Per Diem - Answers Retrospective reimbursement where the payer reimburses the provider a
fixed rate for each day a covered member is hospitalized
Capitation - Answers Prospective reimbursement where the payer reimburses the provider a
fixed, per capita amount for a defined period (Per member per month)
Case Rate - Answers Prospective reimbursement where the payer reimburses the provider one
amount for the entire admission or encounter regardless of the number of services or length of
admission
Global Payment - Answers Prospective reimbursement where there is one combined payment to
cover the services of multiple providers who are treating a single episode of care (typically
physician services/outpatient care)
Bundled Payment - Answers Prospective reimbursement where there is a predetermined
payment amount provided for all services required for a single predefined episode of care.
CMS-HCC Model - Answers Risk adjustment model that uses patient demographic
characteristics and medical conditions to predict the patient's healthcare costs
Risk Adjustment - Answers Statistical process that considers the underlying health status and
health spending of patients when examining their healthcare outcomes or healthcare costs.
Risk Score - Answers Risk score of 1 represents the average Medicare beneficiary
Risk score > 1 means the beneficiary will cost more than the average Medicare beneficiary
Risk score < 1 means the beneficiary will cost less than the average Medicare beneficiary
Raw Risk Score - Answers Demographic + Coding Risk Scores
Federal Register Rule Progression - Answers Notice of Proposed Rule Making -> Comment
Period -> Final Rule
Cost Report - Answers Form that collects information about institutional providers to make
proper determinations of amounts payable under its provisions in various PPPs
