CPI CRISIS PREVENTION INSTITUTE
CERTIFICATION TEST 2026/2027 – VERIFIED
QUESTIONS WITH 100% CORRECT ANSWERS.
◎ Medical coding? ANSWER:- The process of assigning standardized alphanumeric
diagnosis (ICD-10) and procedure (CPT) codes
◎ Role of a medical coder? ANSWER:- Analyzes patient charts and assigns ICD-10
and CPT codes
◎ Role of a medical biller? ANSWER:- Uses medical records to facilitate payment and
reconcile patient accounts
◎ Adjudication? ANSWER:- The process where an insurance payer reviews and settles
a claim
◎ Credentialing? ANSWER:- The process a provider completes to become a network
provider
◎ Copay? ANSWER:- A fixed amount paid by the patient at each visit
◎ Deductible? ANSWER:- The annual out-of-pocket amount a patient must pay before
insurance coverage begins
◎ Coinsurance? ANSWER:- The percentage of costs the patient pays after the
deductible is met
◎ Coordination of benefits? ANSWER:- Determines primary and secondary payers to
prevent duplicate payment
◎ Assignment of benefits? ANSWER:- Allows insurance payment to be sent directly to
the provider
◎ Commercial insurance? ANSWER:- Private for-profit insurance companies (e.g.,
Aetna, BCBS)
◎ Medicare? ANSWER:- Federal insurance for patients ≥65 or with qualifying
conditions
◎ Medicare Part A? ANSWER:- Hospital coverage
◎ Medicare Part B? ANSWER:- Outpatient/physician services
, ◎ Medicare Part C? ANSWER:- Medicare Advantage managed care plans
◎ Medicare Part D? ANSWER:- Prescription drug coverage
◎ Medicaid? ANSWER:- State-administered insurance for low-income or disabled
patients
◎ TRICARE? ANSWER:- Insurance for military personnel and families
◎ Pay for Performance (P4P)? ANSWER:- Payment model rewarding providers for
meeting quality benchmarks
◎ Alternative Payment Models (APMs)? ANSWER:- Value-based systems emphasizing
coordinated care over fee-for-service
◎ MIPS? ANSWER:- Medicare payment system adjusting reimbursement based on
quality, cost, and performance
◎ Incident-to billing? ANSWER:- Medicare rule allowing APP services to be billed at
100% under physician supervision
◎ Requirement for incident-to billing? ANSWER:- Physician must be physically present
in office suite
◎ Established care requirement? ANSWER:- Must follow a physician-established plan
◎ Exclusion for incident-to billing? ANSWER:- Cannot be used for new patients or new
problems
◎ Standard PA reimbursement? ANSWER:- Typically 85% of physician fee schedule
◎ CMS 1500? ANSWER:- Standard form used to submit medical claims
◎ Super bill? ANSWER:- Document listing ICD-10 and CPT codes used during a visit
◎ PHI? ANSWER:- Protected Health Information
◎ HIPAA? ANSWER:- Law regulating patient privacy and data security
◎ Day sheet? ANSWER:- Daily summary of treatments, charges, and payments
◎ ICD-10? ANSWER:- Coding system used to describe diagnoses
◎ ICD-10-CM? ANSWER:- Used for outpatient coding
CERTIFICATION TEST 2026/2027 – VERIFIED
QUESTIONS WITH 100% CORRECT ANSWERS.
◎ Medical coding? ANSWER:- The process of assigning standardized alphanumeric
diagnosis (ICD-10) and procedure (CPT) codes
◎ Role of a medical coder? ANSWER:- Analyzes patient charts and assigns ICD-10
and CPT codes
◎ Role of a medical biller? ANSWER:- Uses medical records to facilitate payment and
reconcile patient accounts
◎ Adjudication? ANSWER:- The process where an insurance payer reviews and settles
a claim
◎ Credentialing? ANSWER:- The process a provider completes to become a network
provider
◎ Copay? ANSWER:- A fixed amount paid by the patient at each visit
◎ Deductible? ANSWER:- The annual out-of-pocket amount a patient must pay before
insurance coverage begins
◎ Coinsurance? ANSWER:- The percentage of costs the patient pays after the
deductible is met
◎ Coordination of benefits? ANSWER:- Determines primary and secondary payers to
prevent duplicate payment
◎ Assignment of benefits? ANSWER:- Allows insurance payment to be sent directly to
the provider
◎ Commercial insurance? ANSWER:- Private for-profit insurance companies (e.g.,
Aetna, BCBS)
◎ Medicare? ANSWER:- Federal insurance for patients ≥65 or with qualifying
conditions
◎ Medicare Part A? ANSWER:- Hospital coverage
◎ Medicare Part B? ANSWER:- Outpatient/physician services
, ◎ Medicare Part C? ANSWER:- Medicare Advantage managed care plans
◎ Medicare Part D? ANSWER:- Prescription drug coverage
◎ Medicaid? ANSWER:- State-administered insurance for low-income or disabled
patients
◎ TRICARE? ANSWER:- Insurance for military personnel and families
◎ Pay for Performance (P4P)? ANSWER:- Payment model rewarding providers for
meeting quality benchmarks
◎ Alternative Payment Models (APMs)? ANSWER:- Value-based systems emphasizing
coordinated care over fee-for-service
◎ MIPS? ANSWER:- Medicare payment system adjusting reimbursement based on
quality, cost, and performance
◎ Incident-to billing? ANSWER:- Medicare rule allowing APP services to be billed at
100% under physician supervision
◎ Requirement for incident-to billing? ANSWER:- Physician must be physically present
in office suite
◎ Established care requirement? ANSWER:- Must follow a physician-established plan
◎ Exclusion for incident-to billing? ANSWER:- Cannot be used for new patients or new
problems
◎ Standard PA reimbursement? ANSWER:- Typically 85% of physician fee schedule
◎ CMS 1500? ANSWER:- Standard form used to submit medical claims
◎ Super bill? ANSWER:- Document listing ICD-10 and CPT codes used during a visit
◎ PHI? ANSWER:- Protected Health Information
◎ HIPAA? ANSWER:- Law regulating patient privacy and data security
◎ Day sheet? ANSWER:- Daily summary of treatments, charges, and payments
◎ ICD-10? ANSWER:- Coding system used to describe diagnoses
◎ ICD-10-CM? ANSWER:- Used for outpatient coding
