EHR CHAPTER 6 EXAM QUESTIONS WITH VERIFIED SOLUTIONS LATEST UPDATE 2026
Abstracting - Answers Collecting data from a health record. Used for determining CPT, HCPCS, OR
ICD-10-CM codes and for release of information.
Abuse - Answers Unintentional deception in which a provider inappropriately bills for services that
are not medically necessary. Examples of abuse is calling patients back for repeated and unnecessary
visits, charging excessively for services and supplies, performing more diagnostic testing than
necessary, and waiving fees and deductibles.
Coding Variance - Answers Medical coding mistakes caused by computer error or by various kinds of
human error from simple carelessness to incorrect application of coding guidelines and procedures.
Compliance Plan - Answers A written set of office policies and procedures intended to ensure
compliance with laws regulating billing, coding, and third-party reimbursement.
CPT (Current Procedural Terminology) - Answers A comprehensive set of medical codes that describe
procedures, treatments, and services for financial reimbursement and analytical purposes. Devised by
American medical association AMA at the request of CMS. Over 10,000 five digit codes.
CPT Manual - Answers Is divided into 3 categories
CMS Centers for Medicare & Medicaid Services - Answers Responsible for issuing periodic rules and
guidelines for how the codes may be applied and for conducting audits when fraud is suspected.
Electronic Data Interchange EDI - Answers The standardized format used to transfer data from one
computer system to another. Quickest way to submit claim. Turnaround for claim may be 14 days and
payments maybe take up to 4 to 6 weeks to be received from paper claims
Eligibility - Answers Entitled to recieve benefits from a health plan.
Encounter form - Answers A form generated to reflect the services and charges for a patient visit .
Patient info and account balance is included.
Fraud - Answers Presenting claims for services that an individual or entity knows or should know to
be false. Examples of fraud are falsifying a providers note, altering test results, misrepresenting the
person who provided the service in order to bill at a higher level, false dates, inserting codes for
services not documented in the patient progress note, duplication claims for reimbursements,
upcoding by changing diagnosis to a false diagnosis, and offering gifts or perks to patients to accept
services that can billed to medicare.
Guarantor - Answers The person who is legally responsible for a patients account. Usually the person
who holds the policy that is over 18 or the parent of a child who holds the policy. (First-party payer)
HIPPA 5010 - Answers The standard electronic claim format used by a noninstitutional provider or
supplier to submit a claim electronically to medicare and most other insurance carriers for covered
services.
ICD-10-CM - Answers International Classification of Diseases, Tenth Revision, withe clinical
Modification. A coding system used to describe the inpatient or out patient diagnosis.
Medical Coding - Answers The process of assigning standard numeric or alphanumeric codes to
diagnosis, procedures, and treatments for research, disease tracking, and reimbursement.
Medical Identity Theft - Answers the unauthorized use of someone else's personal information to
obtain medical services or to submit false insurance claims.
Pay for performance (P4P) - Answers An outcome-based payment model that offers providers
financial incentives for meeting specific standards and electronically documenting compliance with
them.
Third-party Payer - Answers An organization other than the patient, that pays for the incurred
medical expenses. (Insurance) pays the largest share of the claim amount.
Cost sharing - Answers Includes deductible, copayment or coinsurance.
Deductible - Answers Set dollar amount the patient is responsible for annually before their
healthcare plan pays for claims.
- Answers Healthcare plans use a 80/20 split or 90/10 split.
Co payment - Answers Dollar amount the patient's responsible for in reimbursement for an office
visit or emergency department visit. Paid at the time of service.
Medical reimbursement process - Answers Claims are submitted by the provider (the second party)
to Medicare or private insurance carriers (third-party payer) on behalf of the patient (first party payer.
Medical assistant scope of practice - Answers To ensure the patients are billed and credited properly
and to follow up on unpaid claims and delinquent patient accounts.
Abstracting - Answers Collecting data from a health record. Used for determining CPT, HCPCS, OR
ICD-10-CM codes and for release of information.
Abuse - Answers Unintentional deception in which a provider inappropriately bills for services that
are not medically necessary. Examples of abuse is calling patients back for repeated and unnecessary
visits, charging excessively for services and supplies, performing more diagnostic testing than
necessary, and waiving fees and deductibles.
Coding Variance - Answers Medical coding mistakes caused by computer error or by various kinds of
human error from simple carelessness to incorrect application of coding guidelines and procedures.
Compliance Plan - Answers A written set of office policies and procedures intended to ensure
compliance with laws regulating billing, coding, and third-party reimbursement.
CPT (Current Procedural Terminology) - Answers A comprehensive set of medical codes that describe
procedures, treatments, and services for financial reimbursement and analytical purposes. Devised by
American medical association AMA at the request of CMS. Over 10,000 five digit codes.
CPT Manual - Answers Is divided into 3 categories
CMS Centers for Medicare & Medicaid Services - Answers Responsible for issuing periodic rules and
guidelines for how the codes may be applied and for conducting audits when fraud is suspected.
Electronic Data Interchange EDI - Answers The standardized format used to transfer data from one
computer system to another. Quickest way to submit claim. Turnaround for claim may be 14 days and
payments maybe take up to 4 to 6 weeks to be received from paper claims
Eligibility - Answers Entitled to recieve benefits from a health plan.
Encounter form - Answers A form generated to reflect the services and charges for a patient visit .
Patient info and account balance is included.
Fraud - Answers Presenting claims for services that an individual or entity knows or should know to
be false. Examples of fraud are falsifying a providers note, altering test results, misrepresenting the
person who provided the service in order to bill at a higher level, false dates, inserting codes for
services not documented in the patient progress note, duplication claims for reimbursements,
upcoding by changing diagnosis to a false diagnosis, and offering gifts or perks to patients to accept
services that can billed to medicare.
Guarantor - Answers The person who is legally responsible for a patients account. Usually the person
who holds the policy that is over 18 or the parent of a child who holds the policy. (First-party payer)
HIPPA 5010 - Answers The standard electronic claim format used by a noninstitutional provider or
supplier to submit a claim electronically to medicare and most other insurance carriers for covered
services.
ICD-10-CM - Answers International Classification of Diseases, Tenth Revision, withe clinical
Modification. A coding system used to describe the inpatient or out patient diagnosis.
Medical Coding - Answers The process of assigning standard numeric or alphanumeric codes to
diagnosis, procedures, and treatments for research, disease tracking, and reimbursement.
Medical Identity Theft - Answers the unauthorized use of someone else's personal information to
obtain medical services or to submit false insurance claims.
Pay for performance (P4P) - Answers An outcome-based payment model that offers providers
financial incentives for meeting specific standards and electronically documenting compliance with
them.
Third-party Payer - Answers An organization other than the patient, that pays for the incurred
medical expenses. (Insurance) pays the largest share of the claim amount.
Cost sharing - Answers Includes deductible, copayment or coinsurance.
Deductible - Answers Set dollar amount the patient is responsible for annually before their
healthcare plan pays for claims.
- Answers Healthcare plans use a 80/20 split or 90/10 split.
Co payment - Answers Dollar amount the patient's responsible for in reimbursement for an office
visit or emergency department visit. Paid at the time of service.
Medical reimbursement process - Answers Claims are submitted by the provider (the second party)
to Medicare or private insurance carriers (third-party payer) on behalf of the patient (first party payer.
Medical assistant scope of practice - Answers To ensure the patients are billed and credited properly
and to follow up on unpaid claims and delinquent patient accounts.
