Certified Coding Associate (CCA) Exam
Preparation Exam 2025–2026 Accurate Real
Exam Questions and Verified Correct Answers
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c. Improve documentation for patient care and proper reimbursement
Improve documentation to support services billed (Sayles and Gordon 2016, 665). -
answer>>>The purpose of a physician query is to _____.
a. Identify the MS-DRG
b. Identify the principal diagnosis
c. Improve documentation for patient care and proper reimbursement
d. Increase reimbursement as form of optimization
c. Cost outlier
To qualify for a cost outlier, a hospital's charges for a case (adjusted to cost) must exceed
the payment rate for the MS-DRG by a specific threshold amount determined by CMS for
each fiscal year (Hazelwood and Venable 2016, 225). - answer>>>What is the term used
when a Medicare hospital inpatient admission results in exceptionally high costs when
compared to other cases in the same DRG?
a. Rate increase
b. Charge outlier
c. Cost outlier
d. Day outlier
c. A financial management system that contains information about the organization's
charges for the healthcare services it provides to patients
A chargemaster is a financial management form that contains information about the
organization's charges for the healthcare services it provides to patients (Gordon and
Gordon 2016, 424, 426). - answer>>>What is a chargemaster?
,a. Cost-sharing in which the policy or certificate holder pays a preestablished percentage
of eligible expenses after the deductible has been met
b. A plan that converts the organization's goals and objectives into targets for revenue
and spending
c. A financial management system that contains information about the organization's
charges for the healthcare services it provides to patients
d. Charge amounts that are billed as costs by an organization to the current year's
activities of operation
a. Developed by third-party payers and includes a list of healthcare services, procedures,
and charges associated with each
A fee schedule is a list of healthcare services and procedures and charges associated with
each (Gordon and Gordon 2016, 427, 442). - answer>>>A fee schedule is __________.
a. Developed by third-party payers and includes a list of healthcare services, procedures,
and charges associated with each
b. Developed by providers and includes a list of healthcare services, procedures, and
charges associated with each
c. Developed by third-party payers and includes a list of healthcare services provided to a
patient
d. Developed by providers and lists charge codes
b. DRG assignment
The charge description master includes the charge code, charge code description,
CPT/HCPCS code and modifier; revenue code and price (Malmgren and Solberg 2016,
251). - answer>>>The charge description master contains all of the following general data
elements except:
a. Charge code description
b. DRG assignment
c. Insurance coverage determination
d. Price
a. Advance beneficiary notice (ABN)
,An advance beneficiary notice (ABN) must be given to the patient to sign before
treatment if any indication presents that may cause the service to be denied by Medicare
(Hazelwood and Venable 2016, 235-236; Palkie 2016, , 295). - answer>>>If a provider
believes a service may be denied by Medicare because it could be considered
unnecessary, the provider must notify the patient before the treatment begins by using
a(n) _____.
a. Advance beneficiary notice (ABN)
b. Advance notice of coverage (ANC)
c. Notice of payment (NOP)
d. Consent for payment (CFP)
a. Coinsurance or deductible
When a physician accepts assignment of benefits, the physician can only collect any
applicable deductible or coinsurance from the patient (Casto and Forrestal 2015, 154). -
answer>>>Assignment of benefits is a contract between a physician and Medicare in
which the physician agrees to bill Medicare directly for covered services and the
beneficiary for ________ and to accept the Medicare payment as payment in full.
a. Coinsurance or deductible
b. Deductible only
c. Coinsurance only
d. Balance of charges
c. Budget neutrality
Budget neutrality must be maintained annually when the RVUs are adjusted (Casto and
Forrestal 2015, 154). - answer>>>A provision of the law that established the resource-
based relative value scale (RBRVS) stipulates that refinements to relative value units
(RVUs) must maintain _____.
b. Insurance benefit
, Generally, reimbursement for healthcare services is dependent on patients having health
insurance (Casto and Forrestal 2015, 5). - answer>>>Reimbursement for healthcare
services is dependent on patients having a(n) _____.
a. Attending physician
b. Insurance benefit
c. Explanation of benefits
d. Qualified provider
a. Dependent (family) coverage
Health insurance for spouses, children, or both is known as dependent (family) coverage
(Casto and Forrestal 2015, 7). - answer>>>Health insurance for spouses, children, or both
is known as _____.
a. Dependent (family) coverage
b. Individual (single) coverage
c. Group coverage
d. Inclusive coverage
b. History record
A complete medical history documents the patient's current complaints and symptoms
and lists his or her past medical, personal, and family history (Smith 2016, 189-191). -
answer>>>Documentation regarding a patient's marital status; dietary, sleep, and exercise
patterns; and use of coffee, tobacco, alcohol, and other drugs may be found in the:
a. Physical examination record
b. History record
c. Operative report
d. Radiological report
b. Vital signs
Medical history documents the patient's current complaints and symptoms and lists the
patient's past medical, personal, and family history. The physical examination report
Preparation Exam 2025–2026 Accurate Real
Exam Questions and Verified Correct Answers
JUST RELEASED
c. Improve documentation for patient care and proper reimbursement
Improve documentation to support services billed (Sayles and Gordon 2016, 665). -
answer>>>The purpose of a physician query is to _____.
a. Identify the MS-DRG
b. Identify the principal diagnosis
c. Improve documentation for patient care and proper reimbursement
d. Increase reimbursement as form of optimization
c. Cost outlier
To qualify for a cost outlier, a hospital's charges for a case (adjusted to cost) must exceed
the payment rate for the MS-DRG by a specific threshold amount determined by CMS for
each fiscal year (Hazelwood and Venable 2016, 225). - answer>>>What is the term used
when a Medicare hospital inpatient admission results in exceptionally high costs when
compared to other cases in the same DRG?
a. Rate increase
b. Charge outlier
c. Cost outlier
d. Day outlier
c. A financial management system that contains information about the organization's
charges for the healthcare services it provides to patients
A chargemaster is a financial management form that contains information about the
organization's charges for the healthcare services it provides to patients (Gordon and
Gordon 2016, 424, 426). - answer>>>What is a chargemaster?
,a. Cost-sharing in which the policy or certificate holder pays a preestablished percentage
of eligible expenses after the deductible has been met
b. A plan that converts the organization's goals and objectives into targets for revenue
and spending
c. A financial management system that contains information about the organization's
charges for the healthcare services it provides to patients
d. Charge amounts that are billed as costs by an organization to the current year's
activities of operation
a. Developed by third-party payers and includes a list of healthcare services, procedures,
and charges associated with each
A fee schedule is a list of healthcare services and procedures and charges associated with
each (Gordon and Gordon 2016, 427, 442). - answer>>>A fee schedule is __________.
a. Developed by third-party payers and includes a list of healthcare services, procedures,
and charges associated with each
b. Developed by providers and includes a list of healthcare services, procedures, and
charges associated with each
c. Developed by third-party payers and includes a list of healthcare services provided to a
patient
d. Developed by providers and lists charge codes
b. DRG assignment
The charge description master includes the charge code, charge code description,
CPT/HCPCS code and modifier; revenue code and price (Malmgren and Solberg 2016,
251). - answer>>>The charge description master contains all of the following general data
elements except:
a. Charge code description
b. DRG assignment
c. Insurance coverage determination
d. Price
a. Advance beneficiary notice (ABN)
,An advance beneficiary notice (ABN) must be given to the patient to sign before
treatment if any indication presents that may cause the service to be denied by Medicare
(Hazelwood and Venable 2016, 235-236; Palkie 2016, , 295). - answer>>>If a provider
believes a service may be denied by Medicare because it could be considered
unnecessary, the provider must notify the patient before the treatment begins by using
a(n) _____.
a. Advance beneficiary notice (ABN)
b. Advance notice of coverage (ANC)
c. Notice of payment (NOP)
d. Consent for payment (CFP)
a. Coinsurance or deductible
When a physician accepts assignment of benefits, the physician can only collect any
applicable deductible or coinsurance from the patient (Casto and Forrestal 2015, 154). -
answer>>>Assignment of benefits is a contract between a physician and Medicare in
which the physician agrees to bill Medicare directly for covered services and the
beneficiary for ________ and to accept the Medicare payment as payment in full.
a. Coinsurance or deductible
b. Deductible only
c. Coinsurance only
d. Balance of charges
c. Budget neutrality
Budget neutrality must be maintained annually when the RVUs are adjusted (Casto and
Forrestal 2015, 154). - answer>>>A provision of the law that established the resource-
based relative value scale (RBRVS) stipulates that refinements to relative value units
(RVUs) must maintain _____.
b. Insurance benefit
, Generally, reimbursement for healthcare services is dependent on patients having health
insurance (Casto and Forrestal 2015, 5). - answer>>>Reimbursement for healthcare
services is dependent on patients having a(n) _____.
a. Attending physician
b. Insurance benefit
c. Explanation of benefits
d. Qualified provider
a. Dependent (family) coverage
Health insurance for spouses, children, or both is known as dependent (family) coverage
(Casto and Forrestal 2015, 7). - answer>>>Health insurance for spouses, children, or both
is known as _____.
a. Dependent (family) coverage
b. Individual (single) coverage
c. Group coverage
d. Inclusive coverage
b. History record
A complete medical history documents the patient's current complaints and symptoms
and lists his or her past medical, personal, and family history (Smith 2016, 189-191). -
answer>>>Documentation regarding a patient's marital status; dietary, sleep, and exercise
patterns; and use of coffee, tobacco, alcohol, and other drugs may be found in the:
a. Physical examination record
b. History record
c. Operative report
d. Radiological report
b. Vital signs
Medical history documents the patient's current complaints and symptoms and lists the
patient's past medical, personal, and family history. The physical examination report
