HIMS 5620 CUMULATIVE EXAM
REVIEW QUESTIONS AND ANSWERS
GRADED A+ 2026
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? - ANS Deductible and copayment amount
All of the following occurrences are considered "qualifying life events" except: - ANS Car
accident
All of the following types of procedures and services typically require prior authorization except:
- ANS 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? - ANS 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? - ANS Workers' compensation
What is the term that means evaluating, for a healthcare service, the appropriateness of its
setting and its level of service? - ANS Utilization review
An employee paying for 40 percent of the insurance premium through payroll processing is an
example of a transaction between ______ and ______. - ANS Patient; employer
@COPYRIGHT 2026/2027 ALLRIGHTS RESERVED 1
, A physician office submitting an invoice (claim) for payment when the patient has health
insurance is an example of a transaction between ______ and ______. - ANS Provider; third-
party payer
The goal of revenue integrity is to produce a claim that is ______. - ANS Clean, complete, and
compliant
In the US, what is health insurance? - ANS 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? -
ANS 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 ______. -
ANS Packaging
Which of the following does not impact the CMG used in the SNF Services Payment System? -
ANS 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? - ANS Determine the MDC for the principal diagnosis
The variable day adjustment policy is applied to which PDPM components? - ANS 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? -
ANS Determine if the coronary artery bypass procedure is one of the pre-MDC procedures
@COPYRIGHT 2026/2027 ALLRIGHTS RESERVED 2
REVIEW QUESTIONS AND ANSWERS
GRADED A+ 2026
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? - ANS Deductible and copayment amount
All of the following occurrences are considered "qualifying life events" except: - ANS Car
accident
All of the following types of procedures and services typically require prior authorization except:
- ANS 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? - ANS 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? - ANS Workers' compensation
What is the term that means evaluating, for a healthcare service, the appropriateness of its
setting and its level of service? - ANS Utilization review
An employee paying for 40 percent of the insurance premium through payroll processing is an
example of a transaction between ______ and ______. - ANS Patient; employer
@COPYRIGHT 2026/2027 ALLRIGHTS RESERVED 1
, A physician office submitting an invoice (claim) for payment when the patient has health
insurance is an example of a transaction between ______ and ______. - ANS Provider; third-
party payer
The goal of revenue integrity is to produce a claim that is ______. - ANS Clean, complete, and
compliant
In the US, what is health insurance? - ANS 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? -
ANS 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 ______. -
ANS Packaging
Which of the following does not impact the CMG used in the SNF Services Payment System? -
ANS 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? - ANS Determine the MDC for the principal diagnosis
The variable day adjustment policy is applied to which PDPM components? - ANS 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? -
ANS Determine if the coronary artery bypass procedure is one of the pre-MDC procedures
@COPYRIGHT 2026/2027 ALLRIGHTS RESERVED 2
