ADVANCED CODING AND REIMBURSEMENT FINAL EXAM QUESTIONS WITH CORRECT
ANSWERS LATEST UPDATE 2026/2027
The statement "Coding professionals should only assign and report codes that are clearly and
consistently supported by physician documentation in the health record." is an example of ____
Standards for Ethical Coding. - Answers AHIMA's
Part of the ______ legislation includes provisions and funds for the federal government to
investigate fraud and abuse in the Medicare system. - Answers COBRA - Consolidated Omnibus
Reconciliation Act
In the past hospitals used the UB-04 billing form and physician offices and clinics used the CMS
1500 billing form. Today, most claims are submitted electronically using the version ____
electronic transaction set. - Answers 5010
When an employee brings a suit against the employer for alleged fraudulent activities, it is
called ____. - Answers Qui tam action
The official publication for ICD-9-CM coding advice published by AHA is called ________. -
Answers Coding Clinic
Which of the following cooperating organizations maintains a central office to answer ICD-9-CM
coding questions? - Answers American Hospital Association
Which of the following organizations play which role in maintaining or updating ICD-9-CM? -
Answers NCHS recommends changes for the diagnosis side and CMS recommends changes
for the procedure side.
In the United States, what is healthcare insurance? - Answers Reduction of a person's or a
group's exposure to risk for unknown healthcare costs by the assumption of that risk by another
entity
The financial manager of the physician group practice explained that the healthcare insurance
company would be reimbursing the practice for its treatment of the exacerbation of congestive
heart failure that Mrs. Zale experienced. The exacerbation, treatment, and resolution covered
approximately five weeks. This ONE payment covered all the services that Mrs. Zale incurred
during the period. What method of reimbursement was the physician group practice receiving? -
Answers Episode-of-care
In the type of reimbursement methodology does the health insurance company have the
greatest degree of risk because they have to pay for all charges incurred? - Answers
Retrospective fee-for-service
Which of the following represent a core area of what should be covered in a coding compliance
plan? - Answers Policies, procedures, education, training, auditing and monitoring
, In the payment notice (remittance advice) received from Blue Cross/Blue Shield, the healthcare
facility noted that the payment for the individual x-ray test is $109.00. The bill that the radiology
department submitted for the test was $155.00. What does the amount of $109.00 represent? -
Answers Allowable fee
Which healthcare payment method does Medicare use to reimburse physicians based on the
cost of providing services in terms of effort, overhead, and malpractice insurance? - Answers
Resource-based relative value scale
In which type of healthcare payment method, does the healthcare plan oversee both the costs
of healthcare and the outcomes of care? - Answers Managed care
Medicare's payment system for home health services consolidates all types of services, such as
speech, physical, and occupational therapy, into a single lump sum payment. What type of
healthcare payment method does this lump sum payment represent? - Answers Global payment
Insurers pool premium payments for all the insureds in a group, then use actuarial data to
calculate the group's premiums so that: - Answers The pool is large enough to pay losses of the
entire group
All of the following are types of episode-of-care reimbursement except: - Answers Self-insured
plan
Optional HCPCS/CPT tracking codes for performance measurement are known as: - Answers
Category II codes
Which governmental fraud and abuse effort focused on recouping lost funds for the Medicare
Program due to inaccurate coding and billing? $188 million were recovered during the first two
years of this effort. - Answers Operation Restore Trust
The policies and procedures section of a Coding Compliance Plan should include which of the
following: Your physican query process, How to handle coding of diagnoses and procedures not
supported by documentation in the record, Assignment of discharge destination codes -
Answers All of the above
Temporary codes in HCPCS Level II are different than the CPT temporary codes in that: -
Answers HCPCS Level II temporary codes can remain temporary for an infinite time period
The code sets to be used for healthcare services reporting by both public and private insurers
were designated by what legislation? - Answers The Health Insurance Portability and
Accountability Act of 1996 (HIPAA)
What code set was incorporated into the Healthcare Common Procedure Coding System as
HCPCS Level I? - Answers CPT
All of the following are legislated efforts to fight healthcare fraud and abuse except: - Answers
ANSWERS LATEST UPDATE 2026/2027
The statement "Coding professionals should only assign and report codes that are clearly and
consistently supported by physician documentation in the health record." is an example of ____
Standards for Ethical Coding. - Answers AHIMA's
Part of the ______ legislation includes provisions and funds for the federal government to
investigate fraud and abuse in the Medicare system. - Answers COBRA - Consolidated Omnibus
Reconciliation Act
In the past hospitals used the UB-04 billing form and physician offices and clinics used the CMS
1500 billing form. Today, most claims are submitted electronically using the version ____
electronic transaction set. - Answers 5010
When an employee brings a suit against the employer for alleged fraudulent activities, it is
called ____. - Answers Qui tam action
The official publication for ICD-9-CM coding advice published by AHA is called ________. -
Answers Coding Clinic
Which of the following cooperating organizations maintains a central office to answer ICD-9-CM
coding questions? - Answers American Hospital Association
Which of the following organizations play which role in maintaining or updating ICD-9-CM? -
Answers NCHS recommends changes for the diagnosis side and CMS recommends changes
for the procedure side.
In the United States, what is healthcare insurance? - Answers Reduction of a person's or a
group's exposure to risk for unknown healthcare costs by the assumption of that risk by another
entity
The financial manager of the physician group practice explained that the healthcare insurance
company would be reimbursing the practice for its treatment of the exacerbation of congestive
heart failure that Mrs. Zale experienced. The exacerbation, treatment, and resolution covered
approximately five weeks. This ONE payment covered all the services that Mrs. Zale incurred
during the period. What method of reimbursement was the physician group practice receiving? -
Answers Episode-of-care
In the type of reimbursement methodology does the health insurance company have the
greatest degree of risk because they have to pay for all charges incurred? - Answers
Retrospective fee-for-service
Which of the following represent a core area of what should be covered in a coding compliance
plan? - Answers Policies, procedures, education, training, auditing and monitoring
, In the payment notice (remittance advice) received from Blue Cross/Blue Shield, the healthcare
facility noted that the payment for the individual x-ray test is $109.00. The bill that the radiology
department submitted for the test was $155.00. What does the amount of $109.00 represent? -
Answers Allowable fee
Which healthcare payment method does Medicare use to reimburse physicians based on the
cost of providing services in terms of effort, overhead, and malpractice insurance? - Answers
Resource-based relative value scale
In which type of healthcare payment method, does the healthcare plan oversee both the costs
of healthcare and the outcomes of care? - Answers Managed care
Medicare's payment system for home health services consolidates all types of services, such as
speech, physical, and occupational therapy, into a single lump sum payment. What type of
healthcare payment method does this lump sum payment represent? - Answers Global payment
Insurers pool premium payments for all the insureds in a group, then use actuarial data to
calculate the group's premiums so that: - Answers The pool is large enough to pay losses of the
entire group
All of the following are types of episode-of-care reimbursement except: - Answers Self-insured
plan
Optional HCPCS/CPT tracking codes for performance measurement are known as: - Answers
Category II codes
Which governmental fraud and abuse effort focused on recouping lost funds for the Medicare
Program due to inaccurate coding and billing? $188 million were recovered during the first two
years of this effort. - Answers Operation Restore Trust
The policies and procedures section of a Coding Compliance Plan should include which of the
following: Your physican query process, How to handle coding of diagnoses and procedures not
supported by documentation in the record, Assignment of discharge destination codes -
Answers All of the above
Temporary codes in HCPCS Level II are different than the CPT temporary codes in that: -
Answers HCPCS Level II temporary codes can remain temporary for an infinite time period
The code sets to be used for healthcare services reporting by both public and private insurers
were designated by what legislation? - Answers The Health Insurance Portability and
Accountability Act of 1996 (HIPAA)
What code set was incorporated into the Healthcare Common Procedure Coding System as
HCPCS Level I? - Answers CPT
All of the following are legislated efforts to fight healthcare fraud and abuse except: - Answers
