AMCA BILLING & CODING TEST
Questions with Correct Answers and
Rationales
1. Which of the following statements is true under the
doctrine of responsible superior?
a. The billing and coding specialist is superior to other members of
the medical staff
b. The billing and coding specialist is responsible for any errors
made by the medical staff
c. The physician is responsible for any errors made by the
medical staff
d. The person who has been employed for the longest period of time
is responsible for any errors made by the medical staff
Answer: C
Rationale: Responsible superior ("let the master answer") holds
employers (e.g., physicians) liable for employees' actions within
their scope of employment.
2. HIPAA stands for which of the following?
a. Health Insurance Portability and Accountability Act
b. Health Insurance Privacy Assessment and Agreement
c. Health Insurance Privacy and Agreements
d. Health Insurance Practices and Agreements
Answer: A
Rationale: HIPAA ensures patient privacy and standardizes
electronic health transactions.
,3. Information given by a patient to medical personnel that
cannot be disclosed without consent constitutes:
a. Judgment
b. Duty of care
c. Privileged communication
d. Negligence
Answer: C
Rationale: Privileged communication is confidential patient-
provider information protected by law.
4. Why is a superbill/encounter form an important document
in the office?
a. It is used when considering purchasing medical billing software
b. It has information needed for vendors
c. It ensures the correct spelling of the patient's name
d. It ensures the correct patient data information and
procedure codes
Answer: D
Rationale: Superbills capture essential data for accurate billing and
coding.
5. Which of the following facilities does not use CMS-1500
forms?
a. ASC (Ambulatory Surgery Center)
b. Nursing Home
c. Acute care
d. Dialysis clinic
Answer: D
Rationale: Dialysis clinics typically use CMS-1490 forms for
Medicare claims.
,6. What type of insurance allows treatment virtually
anywhere with a high deductible that policy holders are
willing to pay?
a. COBRA
b. EPO
c. PPO
d. HMO
Answer: C
Rationale: PPOs offer flexibility but require higher deductibles for
out-of-network care.
7. Veterans with service-related disabilities are eligible for
care under which program?
a. CHAMPUS
b. Medicare
c. CHAMPVA
d. TRICARE
Answer: C
Rationale: CHAMPVA covers veterans' families and service-disabled
veterans.
8. _____ is usually sponsored and partially paid by an
employer.
a. TRICARE
b. Private Insurance
c. Group Health Insurance
d. Worker's Aide
Answer: C
Rationale: Group health insurance is employer-sponsored.
9. _____ are used to report encounters for circumstances
other than a disease or injury in the ICD-10-CM.
, a. A codes
b. V codes
c. Z codes
d. E codes
Answer: D
Rationale: E codes (External Cause codes) are used for
circumstances like accidents or environmental factors rather than
diseases or injuries.
10. The abbreviation PMPM stands for:
a. Per member per month
b. Provider membership per management
c. Provider management provider manual
d. Pre menstrual after midnight
Answer: A
Rationale: PMPM is a common metric in managed care referring to
capitated payments calculated per member monthly.
11. Schedule of benefits means:
a. Coordination of benefits
b. HMO
c. Medical services covered under the insured's policy
d. Managed care organization
Answer: C
Rationale: A schedule of benefits outlines what services are
covered by an insurance plan.
12. Medicare is funded by:
Questions with Correct Answers and
Rationales
1. Which of the following statements is true under the
doctrine of responsible superior?
a. The billing and coding specialist is superior to other members of
the medical staff
b. The billing and coding specialist is responsible for any errors
made by the medical staff
c. The physician is responsible for any errors made by the
medical staff
d. The person who has been employed for the longest period of time
is responsible for any errors made by the medical staff
Answer: C
Rationale: Responsible superior ("let the master answer") holds
employers (e.g., physicians) liable for employees' actions within
their scope of employment.
2. HIPAA stands for which of the following?
a. Health Insurance Portability and Accountability Act
b. Health Insurance Privacy Assessment and Agreement
c. Health Insurance Privacy and Agreements
d. Health Insurance Practices and Agreements
Answer: A
Rationale: HIPAA ensures patient privacy and standardizes
electronic health transactions.
,3. Information given by a patient to medical personnel that
cannot be disclosed without consent constitutes:
a. Judgment
b. Duty of care
c. Privileged communication
d. Negligence
Answer: C
Rationale: Privileged communication is confidential patient-
provider information protected by law.
4. Why is a superbill/encounter form an important document
in the office?
a. It is used when considering purchasing medical billing software
b. It has information needed for vendors
c. It ensures the correct spelling of the patient's name
d. It ensures the correct patient data information and
procedure codes
Answer: D
Rationale: Superbills capture essential data for accurate billing and
coding.
5. Which of the following facilities does not use CMS-1500
forms?
a. ASC (Ambulatory Surgery Center)
b. Nursing Home
c. Acute care
d. Dialysis clinic
Answer: D
Rationale: Dialysis clinics typically use CMS-1490 forms for
Medicare claims.
,6. What type of insurance allows treatment virtually
anywhere with a high deductible that policy holders are
willing to pay?
a. COBRA
b. EPO
c. PPO
d. HMO
Answer: C
Rationale: PPOs offer flexibility but require higher deductibles for
out-of-network care.
7. Veterans with service-related disabilities are eligible for
care under which program?
a. CHAMPUS
b. Medicare
c. CHAMPVA
d. TRICARE
Answer: C
Rationale: CHAMPVA covers veterans' families and service-disabled
veterans.
8. _____ is usually sponsored and partially paid by an
employer.
a. TRICARE
b. Private Insurance
c. Group Health Insurance
d. Worker's Aide
Answer: C
Rationale: Group health insurance is employer-sponsored.
9. _____ are used to report encounters for circumstances
other than a disease or injury in the ICD-10-CM.
, a. A codes
b. V codes
c. Z codes
d. E codes
Answer: D
Rationale: E codes (External Cause codes) are used for
circumstances like accidents or environmental factors rather than
diseases or injuries.
10. The abbreviation PMPM stands for:
a. Per member per month
b. Provider membership per management
c. Provider management provider manual
d. Pre menstrual after midnight
Answer: A
Rationale: PMPM is a common metric in managed care referring to
capitated payments calculated per member monthly.
11. Schedule of benefits means:
a. Coordination of benefits
b. HMO
c. Medical services covered under the insured's policy
d. Managed care organization
Answer: C
Rationale: A schedule of benefits outlines what services are
covered by an insurance plan.
12. Medicare is funded by:
