AMCA BILLING & CODING TEST 2025 Questions with
100% Correct Answers | Verified | Latest Update
1. A billing and coding specialist discovers that one private payer has not reimbursed the provider for
any claims submitted in the past year. Clean claims have been submitted to the payer and have been
acknowledged. Which of the following entities should the specialist contact to report the payer's
failure to submit timely reimbursement? - ANSWER-a. State Insurance Commissioner's office
1. Which of the following is an example of a diagnostic category code? - ANSWER-a. I10
1. The star symbol in the CPT coding manual is used to indicate which of the following? - ANSWER-a.
Telemedicine
1. Which of the following is an advantage of electronic claim submission? - ANSWER-a. Claims are
expedited
1. When should a billing and coding specialist initiate the collection of the information needed to
process a patient's insurance claim form? - ANSWER-a. When the patient contacts the provider's
office and schedules an appointment
1. A billing and coding specialist is reviewing modifier use with a new employee. Which of the
following scenarios warrants the use of a modifier? - ANSWER-a. Splinting of the fourth digit on the
left foot
1. A billing and coding specialist is reviewing a provider's documentation for a patient who underwent
repair of multiple wounds to the face and trunk. The provider coded repair of all wounds individually.
The specialist should recognize that the provider should have applied which of the following concepts
to the documentation of the repair for this patient's wounds? - ANSWER-a. Wounds should be
grouped by anatomic site and coded in order of complexity
1. Which of the following terms describe the removal of the eye, adnexa, and bony structure? -
ANSWER-a. Exenteration
1. A billing and coding specialist is reviewing delinquent claims and discovers that a third-party payer
paid a claim but applied it to the incorrect provider. The third-party payer will reimburse the payment
once the improperly paid funds are recouped. Which of the following terms is used to describe this
claim? - ANSWER-a. Suspended
1. For which of the following reasons should a claim be resubmitted? - ANSWER-a. The claim requires
an attachment to support medical necessity
1. A billing and coding specialist is preparing an account receivable aging report. The specialist should
expect the report to include which of the following? - ANSWER-a. Outstanding balances organized by
date
1. Which of the following pieces of guarantor information is required when establishing a patient's
financial record? - ANSWER-a. Phone number
1. Which of the following actions by a billing and coding specialist ensures a patient's health
information is protected? - ANSWER-a. Using data encryption software on office workstations
1. A billing and coding specialist is preparing an appeal letter in response to a denial by a third-party
payer for lack of medical necessity. Which of the following should the specialist include with the letter
to indicate medical necessity? - ANSWER-a. Medical record documentation
, 1. A child is brought into a facility by their mother. The child is cover under both parents' insurance
policies. The child's father was born on 10/1/1980 and their mother was born on 10/2/1921. Which of
the following statements is true regarding the primary policy holder for the child? - ANSWER-a. The
father is the primary policy holder because his birthday falls first in the calendar year
1. A billing and coding specialist is processing a claim for a patient who broke their arm while repairing
cars at their workplace. There is no nerve damage, the arm is placed in a cast for 6 weeks, and the
patient is cleared to return to work in 6 weeks. Which of the following types of workers'
compensation applies to this patient? - ANSWER-a. Temporary disability
1. Which of the following information is required on a patient account required? - ANSWER-a. Name
and address of guarantor
1. A billing and coding specialist is reviewing a delinquent claim. Which of the following actions should
the specialist take first? - ANSWER-a. Verify the age of the account
1. A patient presents to a provider's office with difficulty speaking, facial drooping, and an inability to
close their left eye. They are diagnosed with Bell's palsy. A billing and coding specialist should report
which of the following ICD-10-CM codes? - ANSWER-a. G51.0
1. A patient has a breast biopsy with the placement of a clip. After the biopsy is determined to be
malignant, the patient elects for a mastectomy during the global period of the biopsy. Which of the
following modifiers should a billing and coding specialist use to report the mastectomy? - ANSWER--
58
1. A billing and coding specialist is reviewing a report from the clearinghouse after submitting
electronic claims and notices that one claim was rejected due to missing demographic information.
Which of the following actions should the specialist take? - ANSWER-a. Resubmit an updated claim
1. A billing and coding specialist is reviewing a remittance advice from Medicare and notice that the
amount paid for a procedure is less than the contracted amount. Which of the following is potential
reason for the reduced amount of payment? - ANSWER-a. The claim indicated an incorrect place of
service
1. A billing and coding specialist is collecting demographic information from a patient. Which of the
following pieces of information should the specialist expect the Medicaid eligibility verification system
(MEVS) to provide? - ANSWER-a. Dates of coverage
1. Which of the following is the purpose of an internal review in a provider's office? - ANSWER-a. To
verify that the medical records and the billing record match
1. A claim is submitted with a transposed insurance member ID number and returned to the provider.
Which of the following describes the status that will be assigned to the claim by the third-party payer?
- ANSWER-a. Invalid
1. A billing and coding specialist is reviewing a claim for a patient who presented to the provider's
office for an upper respiratory infection. During the encounter, the patient also received the influenza
vaccine. Which of the following modifiers should be attached to the Evaluation and Management
(E/M) code? - ANSWER--25
1. Which of the following is a valid ICD-10-CM principle? - ANSWER-a. Code signs and symptoms in the
absence of a definite diagnosis
1. Which of the following entities are required to follow HIPAA rules and regulations? - ANSWER-a.
Clearinghouses, health insurance companies, and billing services
100% Correct Answers | Verified | Latest Update
1. A billing and coding specialist discovers that one private payer has not reimbursed the provider for
any claims submitted in the past year. Clean claims have been submitted to the payer and have been
acknowledged. Which of the following entities should the specialist contact to report the payer's
failure to submit timely reimbursement? - ANSWER-a. State Insurance Commissioner's office
1. Which of the following is an example of a diagnostic category code? - ANSWER-a. I10
1. The star symbol in the CPT coding manual is used to indicate which of the following? - ANSWER-a.
Telemedicine
1. Which of the following is an advantage of electronic claim submission? - ANSWER-a. Claims are
expedited
1. When should a billing and coding specialist initiate the collection of the information needed to
process a patient's insurance claim form? - ANSWER-a. When the patient contacts the provider's
office and schedules an appointment
1. A billing and coding specialist is reviewing modifier use with a new employee. Which of the
following scenarios warrants the use of a modifier? - ANSWER-a. Splinting of the fourth digit on the
left foot
1. A billing and coding specialist is reviewing a provider's documentation for a patient who underwent
repair of multiple wounds to the face and trunk. The provider coded repair of all wounds individually.
The specialist should recognize that the provider should have applied which of the following concepts
to the documentation of the repair for this patient's wounds? - ANSWER-a. Wounds should be
grouped by anatomic site and coded in order of complexity
1. Which of the following terms describe the removal of the eye, adnexa, and bony structure? -
ANSWER-a. Exenteration
1. A billing and coding specialist is reviewing delinquent claims and discovers that a third-party payer
paid a claim but applied it to the incorrect provider. The third-party payer will reimburse the payment
once the improperly paid funds are recouped. Which of the following terms is used to describe this
claim? - ANSWER-a. Suspended
1. For which of the following reasons should a claim be resubmitted? - ANSWER-a. The claim requires
an attachment to support medical necessity
1. A billing and coding specialist is preparing an account receivable aging report. The specialist should
expect the report to include which of the following? - ANSWER-a. Outstanding balances organized by
date
1. Which of the following pieces of guarantor information is required when establishing a patient's
financial record? - ANSWER-a. Phone number
1. Which of the following actions by a billing and coding specialist ensures a patient's health
information is protected? - ANSWER-a. Using data encryption software on office workstations
1. A billing and coding specialist is preparing an appeal letter in response to a denial by a third-party
payer for lack of medical necessity. Which of the following should the specialist include with the letter
to indicate medical necessity? - ANSWER-a. Medical record documentation
, 1. A child is brought into a facility by their mother. The child is cover under both parents' insurance
policies. The child's father was born on 10/1/1980 and their mother was born on 10/2/1921. Which of
the following statements is true regarding the primary policy holder for the child? - ANSWER-a. The
father is the primary policy holder because his birthday falls first in the calendar year
1. A billing and coding specialist is processing a claim for a patient who broke their arm while repairing
cars at their workplace. There is no nerve damage, the arm is placed in a cast for 6 weeks, and the
patient is cleared to return to work in 6 weeks. Which of the following types of workers'
compensation applies to this patient? - ANSWER-a. Temporary disability
1. Which of the following information is required on a patient account required? - ANSWER-a. Name
and address of guarantor
1. A billing and coding specialist is reviewing a delinquent claim. Which of the following actions should
the specialist take first? - ANSWER-a. Verify the age of the account
1. A patient presents to a provider's office with difficulty speaking, facial drooping, and an inability to
close their left eye. They are diagnosed with Bell's palsy. A billing and coding specialist should report
which of the following ICD-10-CM codes? - ANSWER-a. G51.0
1. A patient has a breast biopsy with the placement of a clip. After the biopsy is determined to be
malignant, the patient elects for a mastectomy during the global period of the biopsy. Which of the
following modifiers should a billing and coding specialist use to report the mastectomy? - ANSWER--
58
1. A billing and coding specialist is reviewing a report from the clearinghouse after submitting
electronic claims and notices that one claim was rejected due to missing demographic information.
Which of the following actions should the specialist take? - ANSWER-a. Resubmit an updated claim
1. A billing and coding specialist is reviewing a remittance advice from Medicare and notice that the
amount paid for a procedure is less than the contracted amount. Which of the following is potential
reason for the reduced amount of payment? - ANSWER-a. The claim indicated an incorrect place of
service
1. A billing and coding specialist is collecting demographic information from a patient. Which of the
following pieces of information should the specialist expect the Medicaid eligibility verification system
(MEVS) to provide? - ANSWER-a. Dates of coverage
1. Which of the following is the purpose of an internal review in a provider's office? - ANSWER-a. To
verify that the medical records and the billing record match
1. A claim is submitted with a transposed insurance member ID number and returned to the provider.
Which of the following describes the status that will be assigned to the claim by the third-party payer?
- ANSWER-a. Invalid
1. A billing and coding specialist is reviewing a claim for a patient who presented to the provider's
office for an upper respiratory infection. During the encounter, the patient also received the influenza
vaccine. Which of the following modifiers should be attached to the Evaluation and Management
(E/M) code? - ANSWER--25
1. Which of the following is a valid ICD-10-CM principle? - ANSWER-a. Code signs and symptoms in the
absence of a definite diagnosis
1. Which of the following entities are required to follow HIPAA rules and regulations? - ANSWER-a.
Clearinghouses, health insurance companies, and billing services
