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HIMS 5620 Exam 2 Questions & Answers (2026) | 400+ Practice Questions | Skilled Nursing Facility, PDPM, OPPS, APCs & Medicare Reimbursement | Health Information Management

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Prepare confidently for HIMS 5620 Exam 2 (2026) with this comprehensive study guide featuring 400+ expertly compiled practice questions and verified answers covering Chapters 6 and 7 of Health Information Management and Healthcare Reimbursement. This exam-focused resource provides in-depth coverage of Skilled Nursing Facilities (SNFs), nursing homes, long-term care, Activities of Daily Living (ADLs), personal care, skilled nursing care, rehabilitation services, Medicare Part A skilled nursing benefits, Patient-Driven Payment Model (PDPM), Resident Assessment Instrument (RAI), Minimum Data Set (MDS 3.0), Care Area Assessment (CAA), Case-Mix Groups (CMGs), Case-Mix Index (CMI), Physical Therapy (PT), Occupational Therapy (OT), Speech-Language Pathology (SLP), Non-Therapy Ancillary (NTA) services, variable day adjustments, HIV/AIDS payment adjustments, Skilled Nursing Facility Value-Based Purchasing (SNF VBP), readmission measures, Outpatient Prospective Payment System (OPPS), Ambulatory Payment Classifications (APCs), Outpatient Code Editor (OCE), packaging, bundling, payment status indicators (SI), Comprehensive APCs (C-APCs), Composite APCs, Conditional APCs, fee schedule reimbursement, reasonable cost reimbursement, pass-through payments, discounting provisions, rural hospital adjustments, cancer hospital adjustments, high-cost outlier payments, conversion factors, payment calculations, Medicare outpatient reimbursement, and healthcare payment methodologies. The guide also includes practical reimbursement scenarios, classification exercises, and exam-style questions that reinforce real-world reimbursement principles and Medicare payment systems. Designed for advanced Health Information Management students, this study guide strengthens both conceptual understanding and practical application through a structured question-and-answer format that promotes active recall and long-term retention. Students will develop a thorough understanding of post-acute care reimbursement, Medicare payment systems, outpatient prospective payment methodologies, coding and reimbursement workflows, payment calculations, case-mix adjustments, and value-based purchasing initiatives. The resource mirrors university examination formats and serves as an excellent companion for classroom learning, independent study, cumulative review, RHIA and RHIT certification preparation, and healthcare reimbursement coursework. The content aligns closely with nationally recognized Health Information Management standards and incorporates concepts established by the American Health Information Management Association (AHIMA), the Centers for Medicare & Medicaid Services (CMS), the American Medical Association (AMA), and official Medicare reimbursement guidelines. It reflects current Medicare payment methodologies, Skilled Nursing Facility reimbursement regulations, Outpatient Prospective Payment System policies, and healthcare revenue cycle best practices used throughout the U.S. healthcare industry. Academic References American Health Information Management Association (AHIMA). (2024). Health Information Management: Concepts, Principles, and Practice. Casto, A. B., & Forrestal, E. J. (2022). Principles of Healthcare Reimbursement (7th ed.). AHIMA Press. Oachs, P. K., & Watters, A. L. (2023). Health Information Management: Concepts, Principles, and Practice (7th ed.). AHIMA Press. Centers for Medicare & Medicaid Services (CMS). (2024). Medicare Claims Processing Manual. Centers for Medicare & Medicaid Services (CMS). (2024). Skilled Nursing Facility Prospective Payment System (SNF PPS) Final Rule. Centers for Medicare & Medicaid Services (CMS). (2024). Hospital Outpatient Prospective Payment System (OPPS) Final Rule. American Medical Association (AMA). (2024). Current Procedural Terminology (CPT®) Professional Edition. National Uniform Billing Committee (NUBC). (2024). Official UB-04 Data Specifications Manual. Relevant Students: This document is ideal for HIMS 5620 students, Health Information Management students, Health Information Technology students, Healthcare Administration students, Revenue Cycle Management students, Medical Billing and Coding students, Health Informatics students, Healthcare Finance students, RHIA candidates, RHIT candidates, Certified Coding Specialist (CCS) candidates, Certified Professional Coder (CPC) candidates, healthcare reimbursement analysts, medical coders, revenue cycle professionals, and students preparing for advanced Health Information Management, Medicare reimbursement, and healthcare payment system examinations. Keywords: HIMS 5620, HIMS Exam 2, Health Information Management, Healthcare Reimbursement, Revenue Cycle Management, Skilled Nursing Facility, SNF, Nursing Home, Long Term Care, Activities of Daily Living, ADLs, Personal Care, Skilled Nursing Care, Rehabilitation Services, Medicare Part A, Patient Driven Payment Model, PDPM, Skilled Nursing Facility Prospective Payment System, SNF PPS, Resident Assessment Instrument, RAI, Minimum Data Set, MDS 3.0, Care Area Assessment, CAA, Case Mix Group, CMG, Case Mix Index, CMI, Physical Therapy, Occupational Therapy, Speech Language Pathology, SLP, Non Therapy Ancillary, NTA, Variable Day Adjustment, HIV AIDS Adjustment, Skilled Nursing Facility Value Based Purchasing, SNF VBP, Readmission Measures, OPPS, Outpatient Prospective Payment System, Ambulatory Payment Classification, APC, Comprehensive APC, C-APC, Composite APC, Payment Status Indicator, Outpatient Code Editor, OCE, Packaging, Bundling, Pass Through Payments, High Cost Outlier, Fee Schedule Reimbursement, Reasonable Cost Reimbursement, Conversion Factor, Medicare Reimbursement, Healthcare Payment Systems, Medical Billing, Medical Coding, Revenue Integrity, Healthcare Finance, Practice Questions, Questions and Answers, Study Guide, Exam Preparation, Revision Notes, RHIA, RHIT, CCS, CPC

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Institution
HIMS 5620
Course
HIMS 5620

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HIMS 5620- Exam 2 (CH 6/7)
2026 Exam Questions and
Correct Answers | New Update



Ch. 6

healthcare facilities that are licensed by a state to offer, on a 24-hour

basis, both skilled nursing care and personal care services -

ANSWER ✔✔Nursing homes


Health services in nursing homes are offered as long-stay and _______.

- ANSWER ✔✔chronic-care


A type of nursing home is a - ANSWER ✔✔skilled nursing facility

(SNF)

-Basic personal activities such as bathing, eating, dressing, etc.

,-Used to measure person's dependency on requiring assistance to

perform any or all activities. - ANSWER ✔✔Activities of daily living


-Custodial care

-Assistance with ADLs , self-administration of medications, light

housekeeping, etc.

-Person would typically complete if they did not have a disability -

ANSWER ✔✔personal care


-Restore function

-Physical therapy, occupational therapy, speech therapy or any

combination of these therapies - ANSWER ✔✔Rehabilitation

Services

Higher level of care, such as injections, cauterizations, and dressing

changes, provided by trained medical professionals, such as physicians,

nurses, and physical therapists - ANSWER ✔✔skilled care


Daily nursing and rehabilitative care that can be performed only by or

under the supervision of skilled medical personnel - ANSWER

✔✔skilled nursing care

,-On an inpatient basis, provides short-term skilled nursing care and

rehabilitation services to Medicare beneficiaries after an acute-care

inpatient hospitalization. - ANSWER ✔✔skilled nursing facility (SNF)


About ___ percent of SNF admissions are in freestanding facilities. -

ANSWER ✔✔95-96%


In the SNF setting patients are referred to as ________. - ANSWER

✔✔residents


T/F SNFs can be freestanding facilities, hospital-based units, or swing

beds in acute-care hospitals. - ANSWER ✔✔True


Medicare part ___ covers the cost of SNF services for Medicare

beneficiaries. - ANSWER ✔✔A


Medicare beneficiaries are eligible for for SNF services immediately after

an acute-care impatient hospitalization of atleast ____ days. They may

receive up to ____ days of SNF covered services per benefit period. -

ANSWER ✔✔3, 100


PDPM stands for - ANSWER ✔✔patient driven payment model


PDPM uses a ___ ___ reimbursement methodology. - ANSWER

✔✔per diem



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3

, The patient-driven payment model (PDPM) was designed to assign

residents to payment categories based on ______ patient/resident

characteristics - ANSWER ✔✔individual


The previous SNF reimbursement classification system was Resource

Utilization Groups (RUGs). RUGs based most reimbursement categories

on the number of______ ________ provided to residents. - ANSWER

✔✔therapy minutes


T/F The change in philosophy to pay reimbursement categories for

individual patient characteristics used in PDPM was based on concerns

regarding thresholding. - ANSWER ✔✔True


_______ is providing just enough therapy for residents to surpass the

relevant therapy thresholds to achieve a higher reimbursement level. -

ANSWER ✔✔Thresholding


SNFs have data reporting requirements related to medical necessity and

development and maintenance of patient care plans. The _____ _____

_______ is used for Medicare. - ANSWER ✔✔Resident Assessment

Instrument (RAI)


What are the 3 Resident Assessment Instrument (RAIs)? - ANSWER

✔✔- Minimum Data Set (MDS) Version 3.0

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