CCA COMPREHENSIVE EXAM 2026 ACTUAL QUESTIONS
AND SOLUTIONS RATED A+
✔✔65. The next generation of consumer-directed healthcare will be driven by a design
where copayments are set based on the value of the clinical services rather than the
traditional practices that focus only on costs of clinical services. What new design will
focus on both the benefit and cost?
a. Value-based insurance design (VBID)
b. Cost-based reimbursement (CBR)
c. Pay for performance design (PPD)
d. Prospective payment system (PPS) - ✔✔a. Value-based insurance design (VBID)
✔✔66. The MS-DRG system creates a hospital's case-mix index (types or categories of
patients treated by the hospital) based on the relative weights of the MS-DRG. The case
mix can be figured by multiplying the relative weight of each MS-DRG by the number of
________ within that MS-DRG.
a. Admissions
b. Discharges
c. CCs
d. MCCs - ✔✔b. Discharges
✔✔67. In processing a bill under the Medicare outpatient prospective payment system
(OPPS) in which a patient had three surgical procedures performed during the same
operative session, which of the following would apply?
a. Bundling of services
b. Outlier adjustment
c. Pass-through payment
d. Discounting of procedures - ✔✔d. Discounting of procedures
✔✔68. Sometimes hospital departments must work together to solve claims issue errors
to prevent them from happening over and over again. What departments would need to
work together if an audit found that the claim did not contain the procedure code or
charge for a pacemaker insertion?
a. Health Information and Business Office
b. Health Information and Materials Management
c. Health Information, Business Office, and Cardiac Department
d. Health Information and Radiology - ✔✔c. Health Information, Business Office, and
Cardiac Department
✔✔69. The goal of coding compliance programs is to reduce:
,a. Liability in regards to fraud and abuse
b. Delays in claims processing
c. Billing errors
d. Inaccurate code assignments - ✔✔a. Liability in regards to fraud and abuse
✔✔70. Medicare's newest claims processing payment contract entities are referred to
as _____.
a. Recovery audit contractors (RACs)
b. Medicare administrative contractors (MACs)
c. Fiscal intermediaries (FIs)
d. Office of Inspector General contractors (OIGCs) - ✔✔b. Medicare administrative
contractors (MACs)
✔✔71. The government sponsored supplemental medical insurance that covers
physicians and surgeons services, emergency department, outpatient clinic, labs and
physical therapy is:
a. Medicaid
b. Medicare Part B
c. Medicare Part A
d. Medicare Part D - ✔✔c. Medicare Part B
✔✔72. What system assigns each service a value representing the true resources
involved in producing it, including the time and intensity of work, the expenses of
practice, and the risk of malpractice?
a. DRGs
b. RVUs
c. CPT
d. SVR - ✔✔b. RVUs
✔✔73. Medicare defines fraud as _____.
a. Billing practices that are inconsistent with generally acceptable fiscal policies
b. Making unintentional billing errors
c. Accurately representing the types of services provided, dates of services, or identity
of the patient
d. Intentional deception or misrepresentation that results in an unauthorized benefit to
an individual - ✔✔d. Intentional deception or misrepresentation that results in an
unauthorized benefit to an individual
✔✔74. What is one way that physicians can prevent or minimize potentially abusive or
fraudulent activities?
, a. Developing a compliance plan
b. Upcoding
c. Unbundling
d. Billing for noncovered services - ✔✔a. Developing a compliance plan
✔✔75. Prospective payment systems were developed by the federal government to:
a. Increase healthcare access
b. Manage Medicare and Medicaid costs
c. Implement managed care programs
d. Eliminate fee-for-service programs - ✔✔b. Manage Medicare and Medicaid costs
✔✔76. When clean claims are submitted, they can be adjudicated in many ways
through computer software automatically. Which statement is not one of the outcomes
that can occur as part of auto-adjudication?
a. Auto-pay
b. Auto-suspend
c. Auto-calculate
d. Auto-deny - ✔✔c. Auto-calculate
✔✔77. Which of the following is not reimbursed according to the Medicare outpatient
prospective payment system?
a. CMHC partial hospitalization services
b. Critical access hospitals
c. Hospital outpatient departments
d. Vaccines provided by CORFs - ✔✔b. Critical access hospitals
✔✔78. Which governmental agency develops an annual work plan that delineates the
specific target areas for Medicare that will be monitored in a given year?
a. Centers for Medicare and Medicaid (CMS)
b. Federal Bureau of Investigation (FBI)
c. Office of Inspector General (OIG)
d. Defense Criminal Investigative Service (DCIS) - ✔✔c. Office of Inspector General
(OIG)
✔✔79. Fee schedules are updated by third-party payers:
a. Annually
b. Monthly
c. Semiannually
d. Weekly - ✔✔a. Annually
AND SOLUTIONS RATED A+
✔✔65. The next generation of consumer-directed healthcare will be driven by a design
where copayments are set based on the value of the clinical services rather than the
traditional practices that focus only on costs of clinical services. What new design will
focus on both the benefit and cost?
a. Value-based insurance design (VBID)
b. Cost-based reimbursement (CBR)
c. Pay for performance design (PPD)
d. Prospective payment system (PPS) - ✔✔a. Value-based insurance design (VBID)
✔✔66. The MS-DRG system creates a hospital's case-mix index (types or categories of
patients treated by the hospital) based on the relative weights of the MS-DRG. The case
mix can be figured by multiplying the relative weight of each MS-DRG by the number of
________ within that MS-DRG.
a. Admissions
b. Discharges
c. CCs
d. MCCs - ✔✔b. Discharges
✔✔67. In processing a bill under the Medicare outpatient prospective payment system
(OPPS) in which a patient had three surgical procedures performed during the same
operative session, which of the following would apply?
a. Bundling of services
b. Outlier adjustment
c. Pass-through payment
d. Discounting of procedures - ✔✔d. Discounting of procedures
✔✔68. Sometimes hospital departments must work together to solve claims issue errors
to prevent them from happening over and over again. What departments would need to
work together if an audit found that the claim did not contain the procedure code or
charge for a pacemaker insertion?
a. Health Information and Business Office
b. Health Information and Materials Management
c. Health Information, Business Office, and Cardiac Department
d. Health Information and Radiology - ✔✔c. Health Information, Business Office, and
Cardiac Department
✔✔69. The goal of coding compliance programs is to reduce:
,a. Liability in regards to fraud and abuse
b. Delays in claims processing
c. Billing errors
d. Inaccurate code assignments - ✔✔a. Liability in regards to fraud and abuse
✔✔70. Medicare's newest claims processing payment contract entities are referred to
as _____.
a. Recovery audit contractors (RACs)
b. Medicare administrative contractors (MACs)
c. Fiscal intermediaries (FIs)
d. Office of Inspector General contractors (OIGCs) - ✔✔b. Medicare administrative
contractors (MACs)
✔✔71. The government sponsored supplemental medical insurance that covers
physicians and surgeons services, emergency department, outpatient clinic, labs and
physical therapy is:
a. Medicaid
b. Medicare Part B
c. Medicare Part A
d. Medicare Part D - ✔✔c. Medicare Part B
✔✔72. What system assigns each service a value representing the true resources
involved in producing it, including the time and intensity of work, the expenses of
practice, and the risk of malpractice?
a. DRGs
b. RVUs
c. CPT
d. SVR - ✔✔b. RVUs
✔✔73. Medicare defines fraud as _____.
a. Billing practices that are inconsistent with generally acceptable fiscal policies
b. Making unintentional billing errors
c. Accurately representing the types of services provided, dates of services, or identity
of the patient
d. Intentional deception or misrepresentation that results in an unauthorized benefit to
an individual - ✔✔d. Intentional deception or misrepresentation that results in an
unauthorized benefit to an individual
✔✔74. What is one way that physicians can prevent or minimize potentially abusive or
fraudulent activities?
, a. Developing a compliance plan
b. Upcoding
c. Unbundling
d. Billing for noncovered services - ✔✔a. Developing a compliance plan
✔✔75. Prospective payment systems were developed by the federal government to:
a. Increase healthcare access
b. Manage Medicare and Medicaid costs
c. Implement managed care programs
d. Eliminate fee-for-service programs - ✔✔b. Manage Medicare and Medicaid costs
✔✔76. When clean claims are submitted, they can be adjudicated in many ways
through computer software automatically. Which statement is not one of the outcomes
that can occur as part of auto-adjudication?
a. Auto-pay
b. Auto-suspend
c. Auto-calculate
d. Auto-deny - ✔✔c. Auto-calculate
✔✔77. Which of the following is not reimbursed according to the Medicare outpatient
prospective payment system?
a. CMHC partial hospitalization services
b. Critical access hospitals
c. Hospital outpatient departments
d. Vaccines provided by CORFs - ✔✔b. Critical access hospitals
✔✔78. Which governmental agency develops an annual work plan that delineates the
specific target areas for Medicare that will be monitored in a given year?
a. Centers for Medicare and Medicaid (CMS)
b. Federal Bureau of Investigation (FBI)
c. Office of Inspector General (OIG)
d. Defense Criminal Investigative Service (DCIS) - ✔✔c. Office of Inspector General
(OIG)
✔✔79. Fee schedules are updated by third-party payers:
a. Annually
b. Monthly
c. Semiannually
d. Weekly - ✔✔a. Annually
