MEDICAL CODING & BILLING CERTIFICATION FINAL EXAM PREP 2025/2026 ACCURATE QUESTIONS AND VERIFIRD CORRECT SOLUTIONS WITH RATIONALES || 100% GUARANTEED PASS <RECENT VERSION>

MEDICAL CODING & BILLING CERTIFICATION FINAL EXAM PREP 2025/2026 ACCURATE QUESTIONS AND VERIFIRD CORRECT SOLUTIONS WITH RATIONALES || 100% GUARANTEED PASS &lt;RECENT VERSION&gt; 1. The document together with the payment voucher that is sent to a physician who has accepted assignment of benefits is referred to as an - ANSWER EOB. 2. All of the following are responsibilities of the insurance payment poster EXCEPT - ANSWER adjusting the amount charged to match the allowable charge. 3. If the insurance billing specialist posts a payment and there is a remaining balance, they should always - ANSWER determine the appropriate course of action. 4. Delinquent claims are claims that have not been paid - ANSWER within 30-45 days of the service date. 5. Documentation from private insurance carriers sent to participating providers that accompanies payment and describes the response to a claim is referred to by the acronym ____________________. - ANSWER EOB 6. An insurance claim that is processed without following specific insurance carrier instructions is considered a/an ____________________ claim. - ANSWER rejected 7. If the medical practice receives payment from an insurance company that is more than the contract rate, it is called a/an ____________________. - ANSWER overpayment 8. The explanation of benefits (EOB), which details the amount allowable, the amount that needs to be adjusted, and the reason why, is issued by the health insurance company. - ANSWER True 9. The status of electronic insurance claims may be accessed quickly through online health insurance physician web portals. - ANSWER True 10. Approximately 50% of individuals pursue appeals on a denied insurance claim. - ANSWER False 11. Workers Compensation is a - ANSWER Federal or state plan 12. Medicare for in the job injury or illness is covered by - ANSWER Workers compensation 13. OWCP is the acronym for - ANSWER Office of workers compensation programs 14. Each _______ administers its own workers compensation program - ANSWER state 15. Copy of the first report of injury must go to the - ANSWER Employer 16. Patients work related injury chart should include - ANSWER Date and time of injury 17. progress report should document - ANSWER treatment and progress 18. Employers name is enter on line_____ of the CMS-1500 claim form - ANSWER 4 19. For workers, comp claims, box for ____ is checked in block 1 - ANSWER FECA 20. Workers compensation claim number is entered in block number - ANSWER 11 21. Category 1 codes describe - ANSWER Procedure or service codes 22. CPT codes have ___ digits - ANSWER 5 23. The code range for the Evaluation and Management codes is - ANSWER 24. The code range for Female Genital System is - ANSWER 25. The CPT code book is revised - ANSWER Annually 26. Codes refers to - ANSWER Radiology 27. Codes 00100-01999 refers to - ANSWER Anesthesia 28. Evaluation and Management codes are for - ANSWER Types of visits 29. The purpose of the CPT codes is to - ANSWER Convert medical descriptions into 5 digit codes 30. The CPT system was developed by the - ANSWER American Medical association 31. Health maintenance Organization - ANSWER HMO 32. Must be signed within 24-72 hours in most states - ANSWER Death certifices 33. HMO - ANSWER Managed care plan that offer benefits to its members if they recieve services from a network providers 34. A review for medical necessity of tests and procedures ordered are called - ANSWER Preauthorizations 35. A collection of data recorded when a patient seeks treatment is called - ANSWER Medical record 36. Document required to release medical records to another physician - ANSWER Authorization 37. Making a copy of the front and back of the insurance card, verifying demographic information - ANSWER The check in process includes 38. private information shared between a patient and health care provider is called - ANSWER Privileged communication 39. A legal proceedings which a party answers questions under oath but not in open court is called - ANSWER Deposition 40. Allows a private citizen to file a lawsuit against U.S. government - ANSWER Qui Tam 41. Law that imposes penalties for breaches of confidentiality regarding medical records that identifies a patient by name. - ANSWER HIPPA 42. Area of law NOT classified as criminal is called - ANSWER CIvil Law 43. Unique identifier ID assigned to health care providers is called - ANSWER UPIN 44. Health care professionals have a duty to - ANSWER Protect the privacy of patients 45. What can NOT be used to correct errors in patient medical records? - ANSWER Correction Fluid 47. ICD-10-CM is a _______. - ANSWER classification 48. What reimbursement system sets payment rates in advance for future inpatient services? - ANSWER IPPS 49. Which system, starting October 1, 2015, classifies hospital inpatient claims for procedures in the U.S.? - ANSWER ICD-10-PCS 50. Codes that identify vendors and products and package size of all drugs are ____. - ANSWER NDC 51. The act of identifying a disease or injury is called __________. Select one: a. Diagnosis b. Etiology c. Screening d. Histology - ANSWER a. Diagnosis 52. Match each meaning to the appropriate word part. *Pus: -tomy, -py(o), -scopy, -lithiasis *Visual examination: -tomy, -py(o), -scopy, -lithiasis *The presence of stones: -tomy, -py(o), -scopy, -lithiasis *Cutting: -tomy, -py(o), -scopy, -lithiasis - ANSWER *Pus: -py(o) *Visual examination: -scopy *The presence of stones: -lithiasis *Cutting: -tomy 53. Ibuprofen is __________. Select one: a. Generic name b. Chemical name c. Trade name d. Family name - ANSWER a. Generic name 54. A sagittal plane divides the body into __________. Select one: a. Upper and lower parts b. Anterior and posterior parts c. Right and left parts d. Distal and proximal parts - ANSWER c. Right and left parts 55. Which term means "relating to a neck or cervix"? Select one: a. Cervical b. Brachial c. Pelvic d. Humeral - ANSWER a. Cervical 56. Anterior means __________. Select one: a. Close to the surface b. Below, lower c. Closer to the front of the body d. Toward the back of the body - ANSWER c. Closer to the front of the body 57. Pharmacology is the study of sources, properties, and uses of drugs. Select one: True False - ANSWER True 58. A frontal, or coronal, plane divides the body vertically into anterior and posterior parts. Select one: True False - ANSWER True 59. Gross anatomy studies __________. Select one: a. The different structures in a certain region b. Structure visible to the unaided eye c. Human development d. Cells - ANSWER b. Structure visible to the unaided eye 60. The study of disease is called ___. a. etiology b. pathology c. diagnosis d. physiology - ANSWER b) pathology 61. Which science studies the surface of the body? a) Regional anatomy b) Systemic anatomy c) Surface anatomy d) Microscopic anatomy - ANSWER c) Surface anatomy 62. In the ICD-10-CM Official Guidelines, the term encounter is used in _____. - ANSWER all settings 63. In the ICD-10-CM Official Guidelines, provider means _____. - ANSWER physician or any qualified health care practitioner legally accountable for a diagnosis 64. Who uses Section II of the ICD-10-CM Official Guidelines for Coding and Reporting? - ANSWER hospital inpatient nursing homes psychiatric hospitals all of the above 65. The diagnosis is probable cirrhosis of the liver. Which setting would report K74.60 (code for cirrhosis of the liver)? - ANSWER hospital inpatient 66. Selection of the principal diagnosis is based on _____. - ANSWER the circumstances of admission 67. When determining principal diagnosis, which of the following is true? - ANSWER ICD-10-CM coding conventions, the Tabular List, and Alphabetic Index take precedence over the official coding guidelines. 68. What is a classification for oncology? - ANSWER ICD-O-3 69. Which is not a section of CPT? - ANSWER rehabilitation 70. Level 1 HCPCS is _________. - ANSWER CPT codes 71. Which would not be a Level 2 HCPCS code? - ANSWER appendectomy 72. Which is an input system? - ANSWER SNOMED CT 73. What is the second part of DSM? - ANSWER diagnostic criteria sets 74. AHA - ANSWER American Hospital Association 75. AHIMA - ANSWER American Health Information Management Association 76. CMS - ANSWER Centers for Medicare and Medicaid Services 77. NCHS - ANSWER National Center for Health Statistics 78. HHS - ANSWER Department of Health and Human Services 79. NCHS - ANSWER A federal organization within the CDC that collects, analyzes, and distributes health care statistics. The NCHS maintains the ICD-n-CM codes. 80. AHA - ANSWER serves as the official U.S. Clearinghouse on medical coding for the proper use of the ICD-9-CM and ICD-10-CM/PCS systems and Level I HCPCS (CPT-4 codes) for hospital providers and certain Level II HCPCS codes for hospitals, physicians and other health professionals. 81. AHIMA - ANSWER educates health information professionals to ensure the patient stays connected to their data throughout the healthcare process. 82. CMS - ANSWER an agency established to oversee various numbers of medical care programs within the U.S. The agency falls under the Department of Health and Human Services (HHS) to ensure smooth administration of all the major medical care programs like Medicaid, Medicare and Health Insurance Exchanges. Intending to run a high-quality health care system CMS offers access to coverage, better medical care, and improved health. 83. HHS - ANSWER risk adjustment model is a concurrent model, which means it uses diagnoses from a time period to predict cost in that same period. All data reporting for the HHS-operated risk adjustment program must include ICD-10-CM codes for claims with dates of service on or after October 1, 2015. 84. When two or more interrelated conditions are present that qualify for principal diagnosis, either may be listed first. 85. Group of answer choices - ANSWER True 86. Possible diabetes mellitus would be reported using the code for diabetes mellitus in the physician setting. - ANSWER False 87. The patient is admitted to the observation unit of the hospital for chest pain. The next day he is admitted to the inpatient floor because of worsening of symptoms and a diagnosis of acute myocardial infarction. The principal diagnosis for the hospital is chest pain. Group of answer choices - ANSWER false 88. The patient came to the surgery center for dilation of esophageal stricture. After anesthesia was administered he experienced arrhythmia, diagnosed as atrial fibrillation, and was admitted to the hospital for treatment. What is the principal diagnosis for the hospital inpatient stay? - ANSWER atrial fibrillation 89. Section III of the ICD-10-CM Coding Guidelines applies to physicians and outpatient services. 90. Group of answer choices - ANSWER False 91. History codes (Z80-Z87) are not used in the inpatient setting. - ANSWER False 92. The patient was in the hospital for dehydration. It was documented by the provider that the blood sugar was extremely high, and the patient was evaluated for diabetes mellitus and started on insulin. Dehydration and diabetes mellitus are coded at discharge. - ANSWER True 93. The inpatient coder notices that the echocardiogram report (interpreted by a physician) has the diagnosis of mitral valve prolapse. This diagnosis was not documented by the provider. At discharge the coder codes mitral valve prolapse as an additional diagnosis. - ANSWER False 94. The patient is admitted for pneumonia. The coder notices low potassium levels in the laboratory report. The physician documents palpitations and prescribes IV potassium chloride. What should the coder do? - ANSWER query the physician to see if the hypokalemia should be added 95. Section IV ICD-10 Guidelines are used by physician services. - ANSWER True 96. Encounter and visit can be used interchangeably in the outpatient setting. - ANSWER True 97. In the physician office, the term principal diagnosis is used. - ANSWER False 98. The patient comes to outpatient surgery for a tonsillectomy for chronic tonsillitis. After recording the temperature, the surgery was postponed because of an acute upper respiratory infection. The acute upper respiratory infection is coded as the primary diagnosis for the encounter. - ANSWER false 99. Sign/symptom codes are appropriate when an established diagnosis has not been made. - ANSWER True 100. The code for acute myocardial infarction would be assigned for the diagnosis of possible acute MI in the emergency room. - ANSWER false 101. Chronic diseases that are being treated may be coded as many times as necessary. - ANSWER True 102. The order for the test states: Rule out mitral valve prolapse. The outpatient coder notices that the echocardiogram report (interpreted by a physician) has the diagnosis of mitral valve prolapse.The coder codes mitral valve prolapse. - ANSWER True