Health Information Management Midterm Exam (2026/2027) |
QUESTIONS AND ANSWERS GRADED A+
Health Information Management (HIM) Midterm Examination | Core Domains: Health Data Structure
& Standards (ICD-10-CM/PCS, CPT, HCPCS), Health Information Governance, Data Quality &
Integrity, Legal & Ethical Issues in HIM, Release of Information, Health Informatics, Privacy & Security
(HIPAA), Clinical Documentation Improvement, and Compliance & Revenue Cycle Management | HIM
Professional Focus | Comprehensive Midterm Assessment Format
Exam Structure
The Health Information Management Midterm Exam for the 2026/2027 academic cycle is a 90-question,
multiple-choice examination.
Introduction
This Health Information Management Midterm Exam guide for the 2026/2027 academic year covers
foundational and intermediate concepts essential for HIM professionals. The content emphasizes accurate
health data management, regulatory compliance, information governance frameworks, and the critical
role of HIM in healthcare quality, reimbursement, and decision support.
Answer Format
All correct answers and HIM standards must be presented in bold and green, followed by detailed
rationales referencing official coding guidelines, HIPAA regulations, AHIMA standards of practice, and
healthcare compliance requirements.
1.
Which organization is responsible for maintaining the ICD-10-CM diagnosis code set in the United States?
A. Centers for Medicare & Medicaid Services (CMS)
B. World Health Organization (WHO)
C. National Center for Health Statistics (NCHS)
D. American Medical Association (AMA)
C. National Center for Health Statistics (NCHS)
Rationale (Coding Standards): The NCHS, part of the CDC, maintains ICD-10-CM for diagnosis coding in
the U.S., while CMS maintains ICD-10-PCS for inpatient procedures. WHO developed the original
ICD-10, but the U.S. clinical modification (CM) is adapted and updated annually by NCHS and CMS
jointly, with NCHS leading the diagnosis side. AHIMA and AMA are professional organizations but not
official maintainers.
2.
Under HIPAA, which of the following is considered a covered entity?
A. A health information management student doing a practicum
,B. A third-party billing company that processes claims for providers
C. A hospital that transmits health information electronically for transactions
D. A software vendor that sells EHR systems
C. A hospital that transmits health information electronically for transactions
Rationale (HIPAA Regulations): HIPAA defines covered entities as healthcare providers, health plans,
and healthcare clearinghouses that conduct standard electronic transactions (e.g., claims, eligibility).
Hospitals meeting this criterion are covered entities. Billing companies are business associates; software
vendors may be business associates but not covered entities unless they also provide care or insurance.
3.
What is the primary purpose of the Minimum Necessary Standard under HIPAA?
A. To limit the amount of protected health information (PHI) used or disclosed to the minimum needed to
accomplish the intended purpose
B. To require all staff to complete annual HIPAA training
C. To mandate encryption of all electronic health records
D. To restrict patient access to their own medical records
A. To limit the amount of protected health information (PHI) used or disclosed to the
minimum needed to accomplish the intended purpose
Rationale (HIPAA Privacy Rule): The Minimum Necessary Standard (45 CFR §164.502(b)) requires
covered entities to evaluate their practices and limit PHI use/disclosure to the least amount necessary for
treatment, payment, or healthcare operations. This protects patient privacy while allowing essential
functions. Exceptions include disclosures to the patient or for treatment.
4.
Which of the following best describes data integrity in health information management?
A. The ability to store data in multiple formats
B. The completeness, accuracy, consistency, and validity of data throughout its lifecycle
C. The speed at which data can be retrieved from the EHR
D. The use of firewalls to protect electronic data
B. The completeness, accuracy, consistency, and validity of data throughout its lifecycle
Rationale (Data Quality & Integrity): Data integrity ensures that health information is trustworthy for
clinical, financial, and legal purposes. AHIMA’s Data Quality Model emphasizes accuracy, completeness,
consistency, timeliness, and validity. Without integrity, coding, billing, and clinical decisions are
compromised.
,5.
A patient requests to amend an error in their medical record. Under HIPAA, what is the facility’s
obligation?
A. Deny the request unless the provider agrees
B. Acknowledge the request within 60 days and either make the amendment or provide a written denial
C. Forward the request to the hospital attorney
D. Charge a fee for processing the amendment
B. Acknowledge the request within 60 days and either make the amendment or provide a
written denial
Rationale (HIPAA Patient Rights): HIPAA’s Right to Amend (45 CFR §164.526) requires covered entities
to respond to amendment requests within 60 days (with one 30-day extension possible). If denied, the
patient must receive a written explanation and may submit a statement of disagreement to be included in
the record. HIM departments manage this process per policy.
6.
Which coding system is used to report physician services and procedures in outpatient settings?
A. ICD-10-CM
B. ICD-10-PCS
C. CPT
D. HCPCS Level II
C. CPT
Rationale (Coding Standards): The Current Procedural Terminology (CPT), maintained by the AMA, is
used to report physician and other qualified healthcare professional services in outpatient and office
settings. ICD-10-CM reports diagnoses; ICD-10-PCS is for inpatient hospital procedures; HCPCS Level II
covers supplies, drugs, and non-physician services (e.g., ambulance).
7.
What is the primary role of a Clinical Documentation Improvement (CDI) specialist?
A. To audit coding accuracy for compliance
B. To ensure clinical documentation supports accurate code assignment and reflects patient severity
C. To manage the release of information process
D. To design the EHR interface for physicians
, B. To ensure clinical documentation supports accurate code assignment and reflects
patient severity
Rationale (Clinical Documentation Improvement): CDI specialists review medical records and query
providers to clarify diagnoses, procedures, and clinical conditions. This ensures documentation is
complete, precise, and compliant, which impacts coding accuracy, reimbursement (e.g., MS-DRG
assignment), quality metrics, and data integrity. AHIMA recognizes CDI as a critical HIM function.
8.
Which of the following is a required element of an accounting of disclosures under HIPAA?
A. The name of the individual who requested the disclosure
B. The date of the disclosure, the name of the entity receiving the PHI, and a brief description of the PHI
disclosed
C. The patient’s Social Security number
D. The diagnosis code associated with the disclosure
B. The date of the disclosure, the name of the entity receiving the PHI, and a brief
description of the PHI disclosed
Rationale (HIPAA Accounting of Disclosures): HIPAA (45 CFR §164.528) requires covered entities to
provide patients, upon request, an accounting of certain disclosures of PHI made in the past 6 years
(excluding treatment, payment, healthcare operations, or with patient authorization). Required elements
include date, recipient name, and a description of the PHI disclosed. SSN and diagnosis codes are not
required in the accounting log.
9.
In the revenue cycle, what is the purpose of charge capture?
A. To verify patient insurance eligibility
B. To assign ICD-10-CM codes for diagnoses
C. To record all billable services provided to a patient
D. To appeal denied insurance claims
C. To record all billable services provided to a patient
Rationale (Revenue Cycle Management): Charge capture is the process of documenting and coding all
services, procedures, and supplies delivered to a patient so they can be billed. Accurate charge capture
ensures complete reimbursement and prevents claim denials due to missing charges. It occurs at the point
of care and is foundational to the billing process.
10.
QUESTIONS AND ANSWERS GRADED A+
Health Information Management (HIM) Midterm Examination | Core Domains: Health Data Structure
& Standards (ICD-10-CM/PCS, CPT, HCPCS), Health Information Governance, Data Quality &
Integrity, Legal & Ethical Issues in HIM, Release of Information, Health Informatics, Privacy & Security
(HIPAA), Clinical Documentation Improvement, and Compliance & Revenue Cycle Management | HIM
Professional Focus | Comprehensive Midterm Assessment Format
Exam Structure
The Health Information Management Midterm Exam for the 2026/2027 academic cycle is a 90-question,
multiple-choice examination.
Introduction
This Health Information Management Midterm Exam guide for the 2026/2027 academic year covers
foundational and intermediate concepts essential for HIM professionals. The content emphasizes accurate
health data management, regulatory compliance, information governance frameworks, and the critical
role of HIM in healthcare quality, reimbursement, and decision support.
Answer Format
All correct answers and HIM standards must be presented in bold and green, followed by detailed
rationales referencing official coding guidelines, HIPAA regulations, AHIMA standards of practice, and
healthcare compliance requirements.
1.
Which organization is responsible for maintaining the ICD-10-CM diagnosis code set in the United States?
A. Centers for Medicare & Medicaid Services (CMS)
B. World Health Organization (WHO)
C. National Center for Health Statistics (NCHS)
D. American Medical Association (AMA)
C. National Center for Health Statistics (NCHS)
Rationale (Coding Standards): The NCHS, part of the CDC, maintains ICD-10-CM for diagnosis coding in
the U.S., while CMS maintains ICD-10-PCS for inpatient procedures. WHO developed the original
ICD-10, but the U.S. clinical modification (CM) is adapted and updated annually by NCHS and CMS
jointly, with NCHS leading the diagnosis side. AHIMA and AMA are professional organizations but not
official maintainers.
2.
Under HIPAA, which of the following is considered a covered entity?
A. A health information management student doing a practicum
,B. A third-party billing company that processes claims for providers
C. A hospital that transmits health information electronically for transactions
D. A software vendor that sells EHR systems
C. A hospital that transmits health information electronically for transactions
Rationale (HIPAA Regulations): HIPAA defines covered entities as healthcare providers, health plans,
and healthcare clearinghouses that conduct standard electronic transactions (e.g., claims, eligibility).
Hospitals meeting this criterion are covered entities. Billing companies are business associates; software
vendors may be business associates but not covered entities unless they also provide care or insurance.
3.
What is the primary purpose of the Minimum Necessary Standard under HIPAA?
A. To limit the amount of protected health information (PHI) used or disclosed to the minimum needed to
accomplish the intended purpose
B. To require all staff to complete annual HIPAA training
C. To mandate encryption of all electronic health records
D. To restrict patient access to their own medical records
A. To limit the amount of protected health information (PHI) used or disclosed to the
minimum needed to accomplish the intended purpose
Rationale (HIPAA Privacy Rule): The Minimum Necessary Standard (45 CFR §164.502(b)) requires
covered entities to evaluate their practices and limit PHI use/disclosure to the least amount necessary for
treatment, payment, or healthcare operations. This protects patient privacy while allowing essential
functions. Exceptions include disclosures to the patient or for treatment.
4.
Which of the following best describes data integrity in health information management?
A. The ability to store data in multiple formats
B. The completeness, accuracy, consistency, and validity of data throughout its lifecycle
C. The speed at which data can be retrieved from the EHR
D. The use of firewalls to protect electronic data
B. The completeness, accuracy, consistency, and validity of data throughout its lifecycle
Rationale (Data Quality & Integrity): Data integrity ensures that health information is trustworthy for
clinical, financial, and legal purposes. AHIMA’s Data Quality Model emphasizes accuracy, completeness,
consistency, timeliness, and validity. Without integrity, coding, billing, and clinical decisions are
compromised.
,5.
A patient requests to amend an error in their medical record. Under HIPAA, what is the facility’s
obligation?
A. Deny the request unless the provider agrees
B. Acknowledge the request within 60 days and either make the amendment or provide a written denial
C. Forward the request to the hospital attorney
D. Charge a fee for processing the amendment
B. Acknowledge the request within 60 days and either make the amendment or provide a
written denial
Rationale (HIPAA Patient Rights): HIPAA’s Right to Amend (45 CFR §164.526) requires covered entities
to respond to amendment requests within 60 days (with one 30-day extension possible). If denied, the
patient must receive a written explanation and may submit a statement of disagreement to be included in
the record. HIM departments manage this process per policy.
6.
Which coding system is used to report physician services and procedures in outpatient settings?
A. ICD-10-CM
B. ICD-10-PCS
C. CPT
D. HCPCS Level II
C. CPT
Rationale (Coding Standards): The Current Procedural Terminology (CPT), maintained by the AMA, is
used to report physician and other qualified healthcare professional services in outpatient and office
settings. ICD-10-CM reports diagnoses; ICD-10-PCS is for inpatient hospital procedures; HCPCS Level II
covers supplies, drugs, and non-physician services (e.g., ambulance).
7.
What is the primary role of a Clinical Documentation Improvement (CDI) specialist?
A. To audit coding accuracy for compliance
B. To ensure clinical documentation supports accurate code assignment and reflects patient severity
C. To manage the release of information process
D. To design the EHR interface for physicians
, B. To ensure clinical documentation supports accurate code assignment and reflects
patient severity
Rationale (Clinical Documentation Improvement): CDI specialists review medical records and query
providers to clarify diagnoses, procedures, and clinical conditions. This ensures documentation is
complete, precise, and compliant, which impacts coding accuracy, reimbursement (e.g., MS-DRG
assignment), quality metrics, and data integrity. AHIMA recognizes CDI as a critical HIM function.
8.
Which of the following is a required element of an accounting of disclosures under HIPAA?
A. The name of the individual who requested the disclosure
B. The date of the disclosure, the name of the entity receiving the PHI, and a brief description of the PHI
disclosed
C. The patient’s Social Security number
D. The diagnosis code associated with the disclosure
B. The date of the disclosure, the name of the entity receiving the PHI, and a brief
description of the PHI disclosed
Rationale (HIPAA Accounting of Disclosures): HIPAA (45 CFR §164.528) requires covered entities to
provide patients, upon request, an accounting of certain disclosures of PHI made in the past 6 years
(excluding treatment, payment, healthcare operations, or with patient authorization). Required elements
include date, recipient name, and a description of the PHI disclosed. SSN and diagnosis codes are not
required in the accounting log.
9.
In the revenue cycle, what is the purpose of charge capture?
A. To verify patient insurance eligibility
B. To assign ICD-10-CM codes for diagnoses
C. To record all billable services provided to a patient
D. To appeal denied insurance claims
C. To record all billable services provided to a patient
Rationale (Revenue Cycle Management): Charge capture is the process of documenting and coding all
services, procedures, and supplies delivered to a patient so they can be billed. Accurate charge capture
ensures complete reimbursement and prevents claim denials due to missing charges. It occurs at the point
of care and is foundational to the billing process.
10.
