HIMS 5620 Final Exam Questions with Correct Answers Latest Update 2026/2027
In this healthcare delivery model, the government is the only payer that funds universal
healthcare coverage through taxes:
a. Social insurance model
b. National health service model
c. Private health insurance model
d. Cash model - Answers b. National health service model
In this healthcare delivery model, the insurance company determines that contribution amount
that isnot based on the policyholder's income:
a. Social insurance model
b. National health service model
c. Private health insurance model
d. Cash model - Answers c. Private health insurance model
In this healthcare delivery model, employees and employers contribute an income-based
amount of money to funds that are regulated by the government:
a. Social insurance model
b. National health service model
c. Private health insurance model
d. Cash model - Answers a. Social insurance model
The US healthcare sector represents a significant portion of the US economy. The trend of
_________ spending on healthcare has been consistent for more than a decade.
a. Steady
b. Decreased
c. Increased - Answers Increased
An employee paying for 40 percent of the insurance premium through payroll processing is an
,example of a transaction between ________ and ________.
a. Patient; provider
b. Employer; third-party payer
c. Patient; third-party payer
d. Patient; employer - Answers d. 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 ________.
a. Provider; third-party payer
b. Employer; third-party payer
c. Patient; third-party payer
d. Patient; employer - Answers a. Provider; third-party payer
Why do health insurers pool premium payments for all the insureds in a group and use actuarial
data to calculate the group's premiums?
a. To increase premium payments for insurance plan payers
b. To simplify accounting for the group's plan
c. To assure that the pool is large enough to pay losses of the entire group
d. To complicate accounting for the group's plan - Answers c. To assure that the pool is large
enough to pay losses of the entire group
Dr. Gilbert sees a 14-old-male with adolescent idiopathic thoracic scoliosis. Surgery for spinal
fusion was cancelled after the patient was diagnosed with mononucleosis. On today's visit the
patient is started on prednisone for severe sore throat and difficulty swallowing. The patient
was accompanied by his parents who have health insurance through the mother's employment
at the State Department of Treasury.
Who is the first party in this healthcare reimbursement scenario?
a. Patient
b. Parents
c. Dr. Gilbert
,d. Insurance company - Answers b. Parents
Dr. Gilbert sees a 14-old-male with adolescent idiopathic thoracic scoliosis. Surgery for spinal
fusion was cancelled after the patient was diagnosed with mononucleosis. On today's visit the
patient is started on prednisone for severe sore throat and difficulty swallowing. The patient
was accompanied by his parents who have health insurance through the mother's employment
at the State Department of Treasury.
Who is the second party in this healthcare reimbursement scenario?
a. Patient
b. Parents
c. Dr. Gilbert
d. Society - Answers c. Dr. Gilbert
Dr. Gilbert sees a 14-old-male with adolescent idiopathic thoracic scoliosis. Surgery for spinal
fusion was cancelled after the patient was diagnosed with mononucleosis. On today's visit the
patient is started on prednisone for severe sore throat and difficulty swallowing. The patient
was accompanied by his parents who have health insurance through the mother's employment
at the State Department of Treasury.
Who is the third party in this healthcare reimbursement scenario?
a. Patient
b. Parents
c. Insurance company
d. State Department of Treasury - Answers c. Insurance company
In the US, what is health insurance?
a. Federal program to provide medical care and services to indigent US citizens
b. State programs to provide medical care and services to deserving individuals
c. 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
d. Set of negotiated guarantees that all healthcare expenses of a risk pool will be covered by
, employers - Answers c. 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
The goal of revenue integrity is to produce a claim that is __________.
a. Clean, complete, and compliant
b. Complete, accurate, and timely
c. Clean, timely, and includes modifiers
d. Compliant, clean, and includes diagnosis - Answers a. Clean, complete, and compliant
Successful RCM programs use this type of approach, which promotes collaboration amount
various clinical departments and emphasizes and education strategy for all members:
a. Multidisciplinary model
b. Silo model
c. Single-minded model
d. Disintegrated model - Answers a. Multidisciplinary model
Which of the following is not a principle of revenue integrity?
a. Operational efficiency
b. No oversight
c. Compliance adherence
d. Focus on legitimate reimbursement - Answers b. No oversight
Which of the following is a key factor in establishing a highly ethical culture promotes honesty
and openness?
a. Ethical standards
b. Oversight
c. Conducting yourself with honor
d. Transparency - Answers d. Transparency
Which of the following is not a component of the revenue cycle?
a. Patient engagement
b. Resource tracking
In this healthcare delivery model, the government is the only payer that funds universal
healthcare coverage through taxes:
a. Social insurance model
b. National health service model
c. Private health insurance model
d. Cash model - Answers b. National health service model
In this healthcare delivery model, the insurance company determines that contribution amount
that isnot based on the policyholder's income:
a. Social insurance model
b. National health service model
c. Private health insurance model
d. Cash model - Answers c. Private health insurance model
In this healthcare delivery model, employees and employers contribute an income-based
amount of money to funds that are regulated by the government:
a. Social insurance model
b. National health service model
c. Private health insurance model
d. Cash model - Answers a. Social insurance model
The US healthcare sector represents a significant portion of the US economy. The trend of
_________ spending on healthcare has been consistent for more than a decade.
a. Steady
b. Decreased
c. Increased - Answers Increased
An employee paying for 40 percent of the insurance premium through payroll processing is an
,example of a transaction between ________ and ________.
a. Patient; provider
b. Employer; third-party payer
c. Patient; third-party payer
d. Patient; employer - Answers d. 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 ________.
a. Provider; third-party payer
b. Employer; third-party payer
c. Patient; third-party payer
d. Patient; employer - Answers a. Provider; third-party payer
Why do health insurers pool premium payments for all the insureds in a group and use actuarial
data to calculate the group's premiums?
a. To increase premium payments for insurance plan payers
b. To simplify accounting for the group's plan
c. To assure that the pool is large enough to pay losses of the entire group
d. To complicate accounting for the group's plan - Answers c. To assure that the pool is large
enough to pay losses of the entire group
Dr. Gilbert sees a 14-old-male with adolescent idiopathic thoracic scoliosis. Surgery for spinal
fusion was cancelled after the patient was diagnosed with mononucleosis. On today's visit the
patient is started on prednisone for severe sore throat and difficulty swallowing. The patient
was accompanied by his parents who have health insurance through the mother's employment
at the State Department of Treasury.
Who is the first party in this healthcare reimbursement scenario?
a. Patient
b. Parents
c. Dr. Gilbert
,d. Insurance company - Answers b. Parents
Dr. Gilbert sees a 14-old-male with adolescent idiopathic thoracic scoliosis. Surgery for spinal
fusion was cancelled after the patient was diagnosed with mononucleosis. On today's visit the
patient is started on prednisone for severe sore throat and difficulty swallowing. The patient
was accompanied by his parents who have health insurance through the mother's employment
at the State Department of Treasury.
Who is the second party in this healthcare reimbursement scenario?
a. Patient
b. Parents
c. Dr. Gilbert
d. Society - Answers c. Dr. Gilbert
Dr. Gilbert sees a 14-old-male with adolescent idiopathic thoracic scoliosis. Surgery for spinal
fusion was cancelled after the patient was diagnosed with mononucleosis. On today's visit the
patient is started on prednisone for severe sore throat and difficulty swallowing. The patient
was accompanied by his parents who have health insurance through the mother's employment
at the State Department of Treasury.
Who is the third party in this healthcare reimbursement scenario?
a. Patient
b. Parents
c. Insurance company
d. State Department of Treasury - Answers c. Insurance company
In the US, what is health insurance?
a. Federal program to provide medical care and services to indigent US citizens
b. State programs to provide medical care and services to deserving individuals
c. 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
d. Set of negotiated guarantees that all healthcare expenses of a risk pool will be covered by
, employers - Answers c. 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
The goal of revenue integrity is to produce a claim that is __________.
a. Clean, complete, and compliant
b. Complete, accurate, and timely
c. Clean, timely, and includes modifiers
d. Compliant, clean, and includes diagnosis - Answers a. Clean, complete, and compliant
Successful RCM programs use this type of approach, which promotes collaboration amount
various clinical departments and emphasizes and education strategy for all members:
a. Multidisciplinary model
b. Silo model
c. Single-minded model
d. Disintegrated model - Answers a. Multidisciplinary model
Which of the following is not a principle of revenue integrity?
a. Operational efficiency
b. No oversight
c. Compliance adherence
d. Focus on legitimate reimbursement - Answers b. No oversight
Which of the following is a key factor in establishing a highly ethical culture promotes honesty
and openness?
a. Ethical standards
b. Oversight
c. Conducting yourself with honor
d. Transparency - Answers d. Transparency
Which of the following is not a component of the revenue cycle?
a. Patient engagement
b. Resource tracking
