Medical Billing & Coding Midterm Questions and Answers | Latest Version | 2025/2026 | Correct & Verified

Medical Billing & Coding Midterm Questions and Answers | Latest Version | 2025/2026 | Correct & Verified What is the main purpose of medical billing and coding? To translate healthcare services into standardized codes for reimbursement and record- keeping. What does the abbreviation EOB stand for in medical billing? Explanation of Benefits. What is the first step in the medical billing process? Patient registration and insurance verification. What is the purpose of the CMS-1500 form? It is used by providers to submit claims for outpatient and professional services. What organization maintains the CPT code set? The American Medical Association (AMA). 2 What does HIPAA primarily protect? Patient health information and privacy. What does ICD-10-CM coding identify? Patient diagnoses and medical conditions. What does CPT coding identify? Medical, surgical, and diagnostic procedures and services. What is the primary goal of revenue cycle management? To ensure timely and accurate payment for healthcare services. What is a deductible in health insurance? The amount a patient must pay before insurance begins to cover costs. What is a co-payment? A fixed amount paid by the patient for a healthcare service. 3 What is the purpose of medical necessity? To ensure services billed are appropriate and justified for a patient’s condition. What is the role of a clearinghouse in medical billing? To review and transmit electronic claims between providers and payers. What is an NPI number used for? To identify healthcare providers in billing and claim submissions. What does the abbreviation POS refer to in billing? Place of Service. What does upcoding mean in medical billing? Billing for a higher-level service than was actually provided. What does downcoding mean in medical billing? Assigning a lower-level code than warranted, often due to insufficient documentation. 4 What is a claim denial? A refusal by an insurance payer to reimburse a submitted claim. What is the purpose of a superbill? It lists the services provided and codes needed for claim submission. What type of code is used for durable medical equipment? HCPCS Level II codes. What does the modifier -25 indicate in CPT coding? A significant, separately identifiable E/M service