HIMS 5620 CUMULATIVE EXAM REVIEW | 92 QUESTIONS
AND ANSWERS | 2026 UPDATE | RATED 100% CORRECT
Wes is enrolled in Medicare Part A. He had his first hospital encounter this
March. He was admitted for congestive heart failure and stayed three days.
Which of the following will Wes need to pay? Answer - Deductible and
copayment amount
All of the following occurrences are considered "qualifying life events" except:
Answer - Car accident
All of the following types of procedures and services typically require prior
authorization except: Answer - Emergency services for suspected stroke
Juan belongs to a managed care plan. He wants to make an appointment with
an out-of-network specialist. The plan has approved the appointment as "out-
of-network." What should Juan expect? Answer - The patient's out-of-pocket
costs will be increased
For what type of care should the physician practice manager expect to work
with a case manager? Answer - Workers' compensation
What is the term that means evaluating, for a healthcare service, the
appropriateness of its setting and its level of service? Answer - Utilization
review
, An employee paying for 40 percent of the insurance premium through payroll
processing is an example of a transaction between ______ and ______. Answer
- Patient; employer
A physician office submitting an invoice (claim) for payment when the patient
has health insurance is an example of a transaction between ______ and
______. Answer - Provider; third-party payer
The goal of revenue integrity is to produce a claim that is ______. Answer -
Clean, complete, and compliant
In the US, what is health insurance? Answer - Reduction of a person's or a
group's exposure to risk for unknown healthcare costs by the assumption of
that risk by an entity
Which element of the relative value unit accounts for the operational costs of
delivering healthcare services, such as rent, wages of technical personnel, and
supplies and equipment? Answer - Practice expense
Reimbursement for minor ancillary services associated with a significant
procedure are combined into a single payment for the procedure. This is the
definition of ______. Answer - Packaging
Which of the following does not impact the CMG used in the SNF Services
Payment System? Answer - Number of therapy hours per week
Fatima is calculating the MS-DRG for an inpatient admission. She has
determined that the encounter does not qualify for pre-MDC assignment.
What is the next step in the MS-DRG assignment process? Answer - Determine
the MDC for the principal diagnosis
AND ANSWERS | 2026 UPDATE | RATED 100% CORRECT
Wes is enrolled in Medicare Part A. He had his first hospital encounter this
March. He was admitted for congestive heart failure and stayed three days.
Which of the following will Wes need to pay? Answer - Deductible and
copayment amount
All of the following occurrences are considered "qualifying life events" except:
Answer - Car accident
All of the following types of procedures and services typically require prior
authorization except: Answer - Emergency services for suspected stroke
Juan belongs to a managed care plan. He wants to make an appointment with
an out-of-network specialist. The plan has approved the appointment as "out-
of-network." What should Juan expect? Answer - The patient's out-of-pocket
costs will be increased
For what type of care should the physician practice manager expect to work
with a case manager? Answer - Workers' compensation
What is the term that means evaluating, for a healthcare service, the
appropriateness of its setting and its level of service? Answer - Utilization
review
, An employee paying for 40 percent of the insurance premium through payroll
processing is an example of a transaction between ______ and ______. Answer
- Patient; employer
A physician office submitting an invoice (claim) for payment when the patient
has health insurance is an example of a transaction between ______ and
______. Answer - Provider; third-party payer
The goal of revenue integrity is to produce a claim that is ______. Answer -
Clean, complete, and compliant
In the US, what is health insurance? Answer - Reduction of a person's or a
group's exposure to risk for unknown healthcare costs by the assumption of
that risk by an entity
Which element of the relative value unit accounts for the operational costs of
delivering healthcare services, such as rent, wages of technical personnel, and
supplies and equipment? Answer - Practice expense
Reimbursement for minor ancillary services associated with a significant
procedure are combined into a single payment for the procedure. This is the
definition of ______. Answer - Packaging
Which of the following does not impact the CMG used in the SNF Services
Payment System? Answer - Number of therapy hours per week
Fatima is calculating the MS-DRG for an inpatient admission. She has
determined that the encounter does not qualify for pre-MDC assignment.
What is the next step in the MS-DRG assignment process? Answer - Determine
the MDC for the principal diagnosis
