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
, HIMS 5620 CUMULATIVE EXAM REVIEW | 92 QUESTIONS AND ANSWERS | 2026 UPDATE |
RATED 100% CORRECT
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
The variable day adjustment policy is applied to which PDPM components? - (ANSWER)PT/OT and
NTA
Mr. Brown was admitted to the hospital with sever chest pains. During this encounter, he underwent
a coronary artery bypass procedure (CABG) due to coronary artery disease (CAD). What is the first
step in determining the MS-DRG assignment for this encounter? - (ANSWER)Determine if the coronary
artery bypass procedure is one of the pre-MDC procedures
Under the OPPS, outpatient services that are similar both clinically and in use of resources are
assigned to separate groups called ______. - (ANSWER)APCs
Jose, who is a Medicare patient, is seen in the Dr. Lee's office. The total charge for the office visit is
$250.00. Jose has previously paid his Medicare Part B deductible. The Medicare fee schedule amount
for this service is $200.00. The nonparticipating Medicare fee schedule amount for this service is
$190.00. Dr. Lee is a Medicare participating physician. What is the total amount of the patient's cost
sharing for this encounter? - (ANSWER)$40
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
, HIMS 5620 CUMULATIVE EXAM REVIEW | 92 QUESTIONS AND ANSWERS | 2026 UPDATE |
RATED 100% CORRECT
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
The variable day adjustment policy is applied to which PDPM components? - (ANSWER)PT/OT and
NTA
Mr. Brown was admitted to the hospital with sever chest pains. During this encounter, he underwent
a coronary artery bypass procedure (CABG) due to coronary artery disease (CAD). What is the first
step in determining the MS-DRG assignment for this encounter? - (ANSWER)Determine if the coronary
artery bypass procedure is one of the pre-MDC procedures
Under the OPPS, outpatient services that are similar both clinically and in use of resources are
assigned to separate groups called ______. - (ANSWER)APCs
Jose, who is a Medicare patient, is seen in the Dr. Lee's office. The total charge for the office visit is
$250.00. Jose has previously paid his Medicare Part B deductible. The Medicare fee schedule amount
for this service is $200.00. The nonparticipating Medicare fee schedule amount for this service is
$190.00. Dr. Lee is a Medicare participating physician. What is the total amount of the patient's cost
sharing for this encounter? - (ANSWER)$40
