AMCA BILLING & CODING EVALUATION EXAM 2026
QUESTIONS AND SOLUTIONS RATED A+
✔✔Past Medical History - ✔✔Explains the patients experiences with illness, injuries,
treatments, hospitalizations, operations, medications, allergies, immunization status,
and diet
✔✔Family History - ✔✔Reviews the medical history of the patients family
✔✔Social History - ✔✔Patients age, marital status, employment
✔✔Health Information Exchange (HIE) - ✔✔Allows providers to share information
through organized networks
✔✔Certification Commission for Healthcare Information Technology (CCHIT) - ✔✔A
private sector organization that certifies electronic health record products
✔✔Simple Fracture - ✔✔Bone does not rupture the skin
✔✔Compound Fracture - ✔✔
✔✔4 Elements of a History - ✔✔Chief complaint, history levels, examination levels,
medical decision making complexity levels
✔✔Straightforward - ✔✔Minimal diagnosis, minimal risk, minimum complexity of data
✔✔Low - ✔✔Limited diagnosis, limited/low risk to patient, limited data
✔✔Moderate - ✔✔Multiple diagnoses, moderate risk to patient, moderate and
complexity of data
✔✔High - ✔✔Extensive diagnoses, high risk to patient, extensive amount and
complexity of data
✔✔Truncated Coding - ✔✔Using diagnosis codes that are not as specific as possible
✔✔Assumption Coding - ✔✔Reporting items or services that are not actually
documented
✔✔Upcoding - ✔✔Using a procedure code that provides a higher reimbursement rate
than the correct code
✔✔External Audits - ✔✔Private payers or government agencies review selected records
of a practice for compliance
, ✔✔Internal Audits - ✔✔Conducted by the medical office staff or a hired consultant
✔✔Retrospective Audits - ✔✔Conducted after the claim has been sent and the
remittance advice has been received
✔✔Write-off - ✔✔When amounts are removed from a balance by the physician office
✔✔Clearing Houses - ✔✔Edits and transmits batches of claims to insurance companies
✔✔Fee Schedule - ✔✔Patient pays physician for professional services performed from
an established schedule of fees (usual, customary, reasonable)
✔✔Capitation - ✔✔Managed care plans that prepaid per person per month regardless
of how many times that patient is seen
✔✔Pre-determination - ✔✔How much will insurance pay or maximum dollar amount for
this service?
✔✔Pre-certification - ✔✔Is the service covered under the insurance plan?
✔✔Pre-authorization - ✔✔Is the service medically necessary?
✔✔Formal Referral - ✔✔Authorization request is required to determine medical
necessity; obtained by phone, mail or fax
✔✔Direct Referral - ✔✔Simplified authorization form is completed and signed by doctor
and handed to patient
✔✔Verbal Referral - ✔✔Primary care doctor calls specialist and indicates approval
✔✔Self Referral - ✔✔Patient refers himself/herself
✔✔Medicare Part A - ✔✔Covers institutional providers for inpatient,hospice, home
health services and services within the hospital
✔✔Medicare Part B - ✔✔Covers outpatient, physician services, DME, clinical lab
services and ambulatory services
✔✔Medicare Part C - ✔✔Combination part A and part B; Managed care plan
✔✔Medicare Part D - ✔✔Covers prescription drugs
QUESTIONS AND SOLUTIONS RATED A+
✔✔Past Medical History - ✔✔Explains the patients experiences with illness, injuries,
treatments, hospitalizations, operations, medications, allergies, immunization status,
and diet
✔✔Family History - ✔✔Reviews the medical history of the patients family
✔✔Social History - ✔✔Patients age, marital status, employment
✔✔Health Information Exchange (HIE) - ✔✔Allows providers to share information
through organized networks
✔✔Certification Commission for Healthcare Information Technology (CCHIT) - ✔✔A
private sector organization that certifies electronic health record products
✔✔Simple Fracture - ✔✔Bone does not rupture the skin
✔✔Compound Fracture - ✔✔
✔✔4 Elements of a History - ✔✔Chief complaint, history levels, examination levels,
medical decision making complexity levels
✔✔Straightforward - ✔✔Minimal diagnosis, minimal risk, minimum complexity of data
✔✔Low - ✔✔Limited diagnosis, limited/low risk to patient, limited data
✔✔Moderate - ✔✔Multiple diagnoses, moderate risk to patient, moderate and
complexity of data
✔✔High - ✔✔Extensive diagnoses, high risk to patient, extensive amount and
complexity of data
✔✔Truncated Coding - ✔✔Using diagnosis codes that are not as specific as possible
✔✔Assumption Coding - ✔✔Reporting items or services that are not actually
documented
✔✔Upcoding - ✔✔Using a procedure code that provides a higher reimbursement rate
than the correct code
✔✔External Audits - ✔✔Private payers or government agencies review selected records
of a practice for compliance
, ✔✔Internal Audits - ✔✔Conducted by the medical office staff or a hired consultant
✔✔Retrospective Audits - ✔✔Conducted after the claim has been sent and the
remittance advice has been received
✔✔Write-off - ✔✔When amounts are removed from a balance by the physician office
✔✔Clearing Houses - ✔✔Edits and transmits batches of claims to insurance companies
✔✔Fee Schedule - ✔✔Patient pays physician for professional services performed from
an established schedule of fees (usual, customary, reasonable)
✔✔Capitation - ✔✔Managed care plans that prepaid per person per month regardless
of how many times that patient is seen
✔✔Pre-determination - ✔✔How much will insurance pay or maximum dollar amount for
this service?
✔✔Pre-certification - ✔✔Is the service covered under the insurance plan?
✔✔Pre-authorization - ✔✔Is the service medically necessary?
✔✔Formal Referral - ✔✔Authorization request is required to determine medical
necessity; obtained by phone, mail or fax
✔✔Direct Referral - ✔✔Simplified authorization form is completed and signed by doctor
and handed to patient
✔✔Verbal Referral - ✔✔Primary care doctor calls specialist and indicates approval
✔✔Self Referral - ✔✔Patient refers himself/herself
✔✔Medicare Part A - ✔✔Covers institutional providers for inpatient,hospice, home
health services and services within the hospital
✔✔Medicare Part B - ✔✔Covers outpatient, physician services, DME, clinical lab
services and ambulatory services
✔✔Medicare Part C - ✔✔Combination part A and part B; Managed care plan
✔✔Medicare Part D - ✔✔Covers prescription drugs
