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Quizzes > Health & Medicine

InterQual test: certification practice quiz for nurses

Quick, free InterQual exam practice-instant results to spot knowledge gaps.

Editorial: Review CompletedCreated By: Dorothy Joy WabinaUpdated Aug 23, 2025
Difficulty: Moderate
2-5mins
Learning OutcomesCheat Sheet
Paper art illustration for InterQual Certification Quiz on dark blue background

This InterQual certification practice quiz helps you apply InterQual Criteria to everyday cases and see where to improve. Get instant results and learn which topics to review next. For more nursing prep, explore our critical care nursing quiz, build rhythm skills with a telemetry practice test, or review med‑surg with cmsrn practice questions.

What is the primary purpose of InterQual Criteria in utilization management?
To provide evidence-based decision support for level-of-care and medical necessity determinations
To mandate specific physician orders for all admissions
To set hospital pricing for inpatient services
To replace payer benefit language with a new coverage policy
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InterQual Acute criteria typically organize the initial review using which framework?
Severity of Illness, Intensity of Service, and Discharge screens
Risk, Reward, and Resource grids
Diagnosis-Related Group and Case Mix Index
Length of Stay and Cost Index
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InterQual Criteria are intended to be used as decision support and do not replace clinical judgment.
True
False
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InterQual updates are typically released on a regular cycle so that criteria reflect current evidence.
False
True
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Using InterQual, Discharge screens help determine whether a patient is ready for transition from acute care.
False
True
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Peer-to-peer (P2P) discussions may be used when initial InterQual-based requests are questioned by the payer.
True
False
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Which InterQual subset is best aligned to evaluate the appropriateness of advanced imaging?
Home Care criteria
Imaging criteria
Acute Rehabilitation criteria
Obstetric criteria
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Which scenario most appropriately aligns with Observation status under InterQual when compared to Inpatient admission?
Hospice care initiation
Short-term monitoring with expected improvement and no need for prolonged acute interventions
Elective outpatient imaging with no monitoring required
Need for long-term rehabilitation services
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InterQual Behavioral Health criteria support level-of-care decisions based on clinical risk, functional impairment, and treatment needs.
True
False
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During a continued stay review with InterQual, the reviewer focuses primarily on which elements?
Hospital billing codes and payer contracts
Admission diagnosis only
Patient demographic data verification
Ongoing clinical stability, response to treatment, and continued need for acute services
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Which best describes how InterQual Criteria relate to payer coverage policies?
They determine premium amounts for members
They override all payer benefit exclusions
They are evidence-based guidelines that inform medical necessity; payers still apply their own benefit rules
They are identical to each payer's internal policy manual
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Which document elements most strengthen an InterQual-based authorization request?
Historical billing totals for the past year
Generic textbook definitions of the condition
Current objective findings, time-stamped vitals and labs, treatment response, and clear clinical rationale
Patient's insurance premium payment history
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Which statement best characterizes InterQual Behavioral Health continued stay determinations?
They depend solely on insurance plan type
They are determined by the patient's residence ZIP code
They are based only on length of stay to date
They evaluate current risk, treatment response, functional status, and need for the current level of care
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InterQual criteria can support discharge planning by identifying when clinical stability and post-acute services are sufficient.
True
False
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When criteria are not met but the patient clearly requires services, which action aligns with InterQual best practice?
Alter the documentation to meet criteria
Document a clear exception/override rationale with supporting clinical evidence and escalate as needed
Submit the request without rationale
Cancel the admission and reschedule
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Which best describes how InterQual interacts with the CMS Two-Midnight standard?
The Two-Midnight standard is derived from InterQual content
InterQual provides clinical necessity support; the Two-Midnight standard is a regulatory benchmark considered alongside
InterQual prohibits use with any regulatory benchmarks
InterQual replaces the Two-Midnight standard entirely
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Which practice enhances inter-rater reliability among InterQual-certified reviewers?
Relying on personal memory without referencing criteria
Rotating reviewers monthly without any overlap
Using standardized training, calibration cases, and periodic competency assessments
Allowing each reviewer to create custom criteria
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In an authorization denial, which is the most appropriate first step when InterQual criteria were met but benefits exclude the service?
Change the diagnosis code to a covered one without clinical basis
Ignore the denial and proceed
Resubmit the same request repeatedly without changes
Verify benefit limitations and discuss alternative covered options with the care team and patient
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When payers use auto-authorization rules mapped to InterQual, what is a key operational risk if documentation is incomplete?
Appropriate cases may incorrectly pend or deny due to missing clinical triggers
Claims automatically pay higher rates
Length of stay instantly increases
All cases bypass review
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InterQual criteria should be cited generically in patient charts without referencing the exact subset used.
True
False
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0

Study Outcomes

  1. Understand InterQual Criteria Basics -

    Grasp the core principles and structure of InterQual Criteria to support accurate clinical decision-making. Gain a foundational overview that underpins effective patient care assessments.

  2. Analyze Clinical Scenarios -

    Examine real-world case studies through interactive quiz questions to sharpen your ability to apply InterQual guidelines. Enhance critical thinking skills by interpreting patient data against established criteria.

  3. Apply Decision-Making Techniques -

    Use InterQual Certification quiz challenges to practice making evidence-based clinical decisions. Reinforce correct usage of criteria in varied healthcare management situations.

  4. Evaluate Patient Acuity Levels -

    Assess patient conditions accurately by aligning symptoms and diagnostics with InterQual acuity definitions. Boost confidence in determining appropriate care levels quickly and efficiently.

  5. Improve Healthcare Management Skills -

    Strengthen your overall healthcare management expertise through targeted questions on resource utilization and policy compliance. Learn how InterQual training online free opportunities can refine your administrative practices.

  6. Identify Knowledge Gaps -

    Reveal areas requiring further study by reviewing instant feedback on quiz performance. Prepare effectively for InterQual Certification by pinpointing and addressing weak spots.

Cheat Sheet

  1. InterQual Criteria Framework -

    The InterQual Certification program is built around three hierarchical modules - Admission, Continued Stay, and Discharge - that guide clinical utilization decisions (McKesson InterQual®). These modules cover acute, behavioral health, and post-acute settings, aligning patient needs with appropriate levels of care. Use the "A-C-D" mnemonic (Admission, Continue, Discharge) to remember the core structure of interqual criteria.

  2. Admission Criteria Essentials -

    Admission criteria assess patient severity and treatment intensity to determine if acute care is warranted (American Journal of Managed Care). For example, sepsis protocols require documented vital-sign instability and lab findings before admission approval. Mastering these rules boosts your performance on any healthcare management quiz or clinical-decision making quiz.

  3. Continued Stay and Discharge Benchmarks -

    Continued stay criteria focus on daily clinical changes and response to treatment, while discharge criteria ensure safe transitions to home or post-acute settings (Agency for Healthcare Research and Quality). For instance, a patient improving off IV antibiotics may meet discharge thresholds. Practicing case scenarios in an interqual training online free environment solidifies your decision-making skills.

  4. Evidence-Based Protocol Alignment -

    InterQual integrates guidelines from ACC/AHA, CDC, and specialty societies to ensure evidence-based clinical pathways (Journal of Healthcare Quality). Familiarize yourself with sensitivity/specificity trade-offs in key algorithms - like chest pain triage - to optimize utilization reviews. A useful tip: chart "rule-in" and "rule-out" criteria side by side for faster recall.

  5. Documentation, Appeals, and Compliance -

    Accurate clinical documentation underpins interqual certification and reduces appeals by payers (AHIMA Practice Briefs). Include precise diagnostic codes, progress notes highlighting criteria met, and physician signatures for legal compliance. Remember the "3-D" checklist - Data, Documentation, Determination - to streamline your clinical-decision making quiz prep and real-world reviews.

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