MEDICAL CODING AND BILLING PRACTICE EXAM
2025/2026 QUESTIONS WITH ANSWERS GRADED A+
✔✔Level II codes - ✔✔are alphanumeric still containing five characters but starting with
a letter.
✔✔Encounter forms, also referred to as superbills - ✔✔are used by medical practices to
outline the services there were provided to a patient for insurance processing.
✔✔The CMS-1500 insurance claim form - ✔✔This form is a uniform document that
ensures all providers and insurers use the same format regarding insurance claims
✔✔CMS-1500/837P forms to be completed - ✔✔It is a good idea for billing
professionals to refer to the specific guidelines on how each entity wants to be billed.
✔✔The UB-04 (CMS-1450) insurance claim form and its electronic equivalent known as
837I - ✔✔are used in reimbursement for medical services provided by institutional
healthcare providers
✔✔Payer payment policies - ✔✔a certified staff member that is responsible for the
collection of copayments
✔✔Usual, Customary, and Reasonable (UCR) - ✔✔individual doctors' charge profiles
and customary charge screens for similar groupings of physicians within a geographic
area with similar expertise
✔✔Usual - ✔✔fee normally charged for a given service
✔✔Customary - ✔✔fee in the range of usual fees charged by physicians of similar
training and experience for same service within the same specific and limited
socioeconomic area
✔✔Reasonable - ✔✔fee that is considered justifiable by responsible medical opinion
considering special circumstances of the particular case in question
✔✔Relative Value Studies (RVS) - ✔✔a list of 5-digit procedure codes for services with
unit values that indicate the value for each procedure
✔✔How to identify fraud and abuse as it pertains to coding - ✔✔Compliance in this area
can enhance operations, reduce waste and fraud, and foster ethical practices that
improves the overall delivery of patient care.
✔✔External Audits - ✔✔Conducted by an outside entity; Private payers or government
agencies can review selected records of a practice for compliance
2025/2026 QUESTIONS WITH ANSWERS GRADED A+
✔✔Level II codes - ✔✔are alphanumeric still containing five characters but starting with
a letter.
✔✔Encounter forms, also referred to as superbills - ✔✔are used by medical practices to
outline the services there were provided to a patient for insurance processing.
✔✔The CMS-1500 insurance claim form - ✔✔This form is a uniform document that
ensures all providers and insurers use the same format regarding insurance claims
✔✔CMS-1500/837P forms to be completed - ✔✔It is a good idea for billing
professionals to refer to the specific guidelines on how each entity wants to be billed.
✔✔The UB-04 (CMS-1450) insurance claim form and its electronic equivalent known as
837I - ✔✔are used in reimbursement for medical services provided by institutional
healthcare providers
✔✔Payer payment policies - ✔✔a certified staff member that is responsible for the
collection of copayments
✔✔Usual, Customary, and Reasonable (UCR) - ✔✔individual doctors' charge profiles
and customary charge screens for similar groupings of physicians within a geographic
area with similar expertise
✔✔Usual - ✔✔fee normally charged for a given service
✔✔Customary - ✔✔fee in the range of usual fees charged by physicians of similar
training and experience for same service within the same specific and limited
socioeconomic area
✔✔Reasonable - ✔✔fee that is considered justifiable by responsible medical opinion
considering special circumstances of the particular case in question
✔✔Relative Value Studies (RVS) - ✔✔a list of 5-digit procedure codes for services with
unit values that indicate the value for each procedure
✔✔How to identify fraud and abuse as it pertains to coding - ✔✔Compliance in this area
can enhance operations, reduce waste and fraud, and foster ethical practices that
improves the overall delivery of patient care.
✔✔External Audits - ✔✔Conducted by an outside entity; Private payers or government
agencies can review selected records of a practice for compliance
