Review 2026 Exam Questions
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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