CHAMBERLAIN COLLEGE OF NURSING
NR 533 Week 7 Business Plan Assignment
Financial Management in Healthcare Organizations
Official Practice Exam | 2026/2027 Edition
50 Questions 90 Minutes 80% Passing Score Recertification
TABLE OF CONTENTS
Section 1: Healthcare Financial Environment and Revenue Cycle .......... Q1-Q14 (14 questions)
Section 2: Budgeting and Cost Analysis in Healthcare .......... Q15-Q28 (14 questions)
Section 3: Business Plan Development and Capital Management .......... Q29-Q40 (12 questions)
Section 4: Financial Performance Evaluation and Strategic Decision Making .......... Q41-Q50 (10 questions)
INSTRUCTIONS
Read each question carefully. Select the single best answer from the four options provided. Each question is worth equal
points. You have 90 minutes to complete all 50 questions. A score of 80% or higher (40/50) is required to pass. No
electronic devices are permitted. Mark your answers on the separate answer sheet provided. Review the rationale after
each question for learning purposes.
NR 533 Financial Management -- 2026/2027 | Passing Score: 80% | Page 1 of
, Section 1: Healthcare Financial Environment and Revenue Cycle -- 2026/2027
Q1 Question 1 of 50
A 350-bed community hospital is experiencing cash flow difficulties despite reporting positive net
income on its income statement. The CFO notes that accounts receivable days have increased from
45 to 72 days over the past six months. This discrepancy between net income and cash flow is most
likely explained by which financial principle?
A. Depreciation expense artificially inflates net income
B. Capital expenditures are recorded as operating expenses
C. Tax liabilities reduce cash but not net income
D. Accrual accounting recognizes revenue when earned, not when cash is received
Correct Answer: B
Rationale:
Accrual accounting records revenue when services are rendered, regardless of when payment is received, creating a
timing difference between reported income and actual cash flow. The increase in accounts receivable days confirms
that revenue is being recognized faster than cash is being collected. Depreciation actually reduces net income, not
inflates it, and capital expenditures are not recorded as operating expenses.
Q2 Question 2 of 50
A nurse manager at an outpatient surgery center is reviewing the facility's revenue cycle and notices
a high rate of claim denials from a major commercial payer. The denials are primarily coded as
'medical necessity not established.' The most effective strategy to reduce these denials would be to
implement which intervention?
A. Retroactive appeals of all denied claims with additional clinical notes
B. Negotiation of higher reimbursement rates with the commercial payer
C. Transfer of all denied claims to an external collection agency
D. Prospective pre-authorization and clinical documentation improvement programs
Correct Answer: B
Rationale:
Prospective pre-authorization ensures medical necessity is established before services are rendered, and clinical
documentation improvement ensures records support the diagnosis codes billed. Retroactive appeals are costly and
have low success rates, negotiating rates does not address the root cause of denials, and collection agencies cannot
recover improperly denied claims.
NR 533 Financial Management -- 2026/2027 | Passing Score: 80% | Page 2 of
, Q3 Question 3 of 50
A hospital's revenue cycle team is analyzing the impact of a new payer contract that shifts
reimbursement from a fee-for-service model to a bundled payment arrangement. Under the bundled
payment model, the hospital bears financial risk for which scenario?
A. Volume of services exceeding projected utilization targets
B. Patient satisfaction scores falling below benchmark thresholds
C. Physician productivity declining below historical levels
D. Costs of care exceeding the bundled payment amount for an episode
Correct Answer: B
Rationale:
Under bundled payments, the hospital receives a fixed amount for an entire episode of care and bears the risk if the
actual costs of delivering that care exceed the bundled rate. Fee-for-service shifts volume risk to the payer, patient
satisfaction affects value-based incentives separately, and physician productivity is an operational concern, not a
bundled payment risk.
Q4 Question 4 of 50
A healthcare system is evaluating whether to outsource its billing and collections function to a
revenue cycle management company. The current in-house cost for billing operations is $2.4 million
annually, and the RCM company proposes a fee of 5% of net collections, which are projected at $44
million. From a purely financial perspective, which option is more cost-effective?
A. The RCM proposal saves $200,000 compared to in-house operations
B. Both options have equal cost
C. In-house operations cost $400,000 more than the RCM proposal
D. In-house operations cost $200,000 less than the RCM proposal
Correct Answer: B
Rationale:
The RCM company fee would be 5% of $44 million = $2.2 million, compared to $2.4 million for in-house operations,
making the RCM proposal $200,000 less expensive. However, this analysis only considers direct costs and does not
account for potential quality differences, transition costs, or loss of institutional knowledge that may accompany
outsourcing.
NR 533 Financial Management -- 2026/2027 | Passing Score: 80% | Page 3 of
NR 533 Week 7 Business Plan Assignment
Financial Management in Healthcare Organizations
Official Practice Exam | 2026/2027 Edition
50 Questions 90 Minutes 80% Passing Score Recertification
TABLE OF CONTENTS
Section 1: Healthcare Financial Environment and Revenue Cycle .......... Q1-Q14 (14 questions)
Section 2: Budgeting and Cost Analysis in Healthcare .......... Q15-Q28 (14 questions)
Section 3: Business Plan Development and Capital Management .......... Q29-Q40 (12 questions)
Section 4: Financial Performance Evaluation and Strategic Decision Making .......... Q41-Q50 (10 questions)
INSTRUCTIONS
Read each question carefully. Select the single best answer from the four options provided. Each question is worth equal
points. You have 90 minutes to complete all 50 questions. A score of 80% or higher (40/50) is required to pass. No
electronic devices are permitted. Mark your answers on the separate answer sheet provided. Review the rationale after
each question for learning purposes.
NR 533 Financial Management -- 2026/2027 | Passing Score: 80% | Page 1 of
, Section 1: Healthcare Financial Environment and Revenue Cycle -- 2026/2027
Q1 Question 1 of 50
A 350-bed community hospital is experiencing cash flow difficulties despite reporting positive net
income on its income statement. The CFO notes that accounts receivable days have increased from
45 to 72 days over the past six months. This discrepancy between net income and cash flow is most
likely explained by which financial principle?
A. Depreciation expense artificially inflates net income
B. Capital expenditures are recorded as operating expenses
C. Tax liabilities reduce cash but not net income
D. Accrual accounting recognizes revenue when earned, not when cash is received
Correct Answer: B
Rationale:
Accrual accounting records revenue when services are rendered, regardless of when payment is received, creating a
timing difference between reported income and actual cash flow. The increase in accounts receivable days confirms
that revenue is being recognized faster than cash is being collected. Depreciation actually reduces net income, not
inflates it, and capital expenditures are not recorded as operating expenses.
Q2 Question 2 of 50
A nurse manager at an outpatient surgery center is reviewing the facility's revenue cycle and notices
a high rate of claim denials from a major commercial payer. The denials are primarily coded as
'medical necessity not established.' The most effective strategy to reduce these denials would be to
implement which intervention?
A. Retroactive appeals of all denied claims with additional clinical notes
B. Negotiation of higher reimbursement rates with the commercial payer
C. Transfer of all denied claims to an external collection agency
D. Prospective pre-authorization and clinical documentation improvement programs
Correct Answer: B
Rationale:
Prospective pre-authorization ensures medical necessity is established before services are rendered, and clinical
documentation improvement ensures records support the diagnosis codes billed. Retroactive appeals are costly and
have low success rates, negotiating rates does not address the root cause of denials, and collection agencies cannot
recover improperly denied claims.
NR 533 Financial Management -- 2026/2027 | Passing Score: 80% | Page 2 of
, Q3 Question 3 of 50
A hospital's revenue cycle team is analyzing the impact of a new payer contract that shifts
reimbursement from a fee-for-service model to a bundled payment arrangement. Under the bundled
payment model, the hospital bears financial risk for which scenario?
A. Volume of services exceeding projected utilization targets
B. Patient satisfaction scores falling below benchmark thresholds
C. Physician productivity declining below historical levels
D. Costs of care exceeding the bundled payment amount for an episode
Correct Answer: B
Rationale:
Under bundled payments, the hospital receives a fixed amount for an entire episode of care and bears the risk if the
actual costs of delivering that care exceed the bundled rate. Fee-for-service shifts volume risk to the payer, patient
satisfaction affects value-based incentives separately, and physician productivity is an operational concern, not a
bundled payment risk.
Q4 Question 4 of 50
A healthcare system is evaluating whether to outsource its billing and collections function to a
revenue cycle management company. The current in-house cost for billing operations is $2.4 million
annually, and the RCM company proposes a fee of 5% of net collections, which are projected at $44
million. From a purely financial perspective, which option is more cost-effective?
A. The RCM proposal saves $200,000 compared to in-house operations
B. Both options have equal cost
C. In-house operations cost $400,000 more than the RCM proposal
D. In-house operations cost $200,000 less than the RCM proposal
Correct Answer: B
Rationale:
The RCM company fee would be 5% of $44 million = $2.2 million, compared to $2.4 million for in-house operations,
making the RCM proposal $200,000 less expensive. However, this analysis only considers direct costs and does not
account for potential quality differences, transition costs, or loss of institutional knowledge that may accompany
outsourcing.
NR 533 Financial Management -- 2026/2027 | Passing Score: 80% | Page 3 of
