Medical Coding Chapter 1 Review (50+ Q&A) – Medicare, MACs, Parts A–D, HIPAA, Reimbursement | 2025/2026

This foundational chapter review includes over 50 expertly answered questions based on Chapter 1 of a 2025/2026 Medical Coding curriculum, offering in-depth explanations of core healthcare billing systems, regulatory frameworks, and payer structures in the U.S. healthcare system. It is tailored for early-term students and exam-takers seeking clarity on Medicare and its supporting agencies, coding compliance, and insurance processes. Main topics include: Medicare structure and funding: Roles of Parts A (hospital), B (physician), C (Medicare Advantage), and D (prescription drug) Third-party payer hierarchy: U.S. federal government as the largest payer, and the role of CMS (Centers for Medicare & Medicaid Services) in oversight Medicare Administrative Contractors (MACs): Their function in claims processing and day-to-day operations Medicare payment structure: Deductibles, premiums, coinsurance, limiting charge, and the impact of QIO participation (Quality Improvement Organizations) on reimbursement Regulatory laws and manuals: HIPAA (Health Insurance Portability and Accountability Act), Internet-Only Manuals (IOMs), and HMO structures (gatekeepers, staff and individual models) Electronic healthcare data exchange: Key terms like transactions, transmissions, and Medicare EDI protocols Perfect for: Medical coding and billing students (CPC, CCS, CBCS prep) HIT and HIM learners starting coursework on reimbursement systems Healthcare professionals reviewing Medicare structure and claim processing roles Tutors and instructors using foundational chapter reviews in class Keywords: Medicare Parts A B C D, CMS, Medicare administrative contractors, MACs, HIPAA, coinsurance, gatekeeper, deductible, limiting charge, claim processing, CPT reimbursement, physician fee schedule, IOM manual, Medicare Advantage, third-party payers