MEDICAL BILLING CODING COMPREHENSIVE 2026/2027
EXAM QUESTIONS AND ANSWERS RATED A+
✔✔(RAC) Recovery audit Contractor - ✔✔Which of the following organizations identifies
improper payments made on CMS claims
✔✔Bone and bone marrow - ✔✔IF a patient has osteomyelitis he has problems with
which of the following areas?
✔✔Preauthorization form - ✔✔Which of the following is a requirement of some third-
party payers before a procedure is performed?
✔✔Precertification - ✔✔Ensure appropriate insurance coverage for an outpatient
procedure by first using the following process
✔✔History - ✔✔Key component if an evaluation and management service
✔✔837 - ✔✔Format used to submit electronic claims and 3rd Party payer
✔✔Office of the Inspector General (OIG) - ✔✔Entity that defines the essential element
of a comprehensive compliance program
✔✔National Coverage Determination - ✔✔Medicare Policy determines if a particular
item or service is covered
✔✔Left upper quadrant - ✔✔Location of the stomach, spleen, part of the pancreas and
liver
✔✔18% - ✔✔Coding a front torso burn, what % should be used?
✔✔An italicized code used as the 1st listed diagnosis - ✔✔Result of a claim being
denied
✔✔Charging excessive fees - ✔✔Example of Medicare abuse
✔✔Codes must correspond to the diagnosis pointer in block 24E - ✔✔Diagnostic codes
in Block 21 of the CMS form
✔✔(S) Subjective - ✔✔Soap note to indicate patient level of pain to provider
✔✔HIPPA Standard transaction - ✔✔Standardized format used in electronic filing of
claims
✔✔3rd Party Payer - ✔✔Insurance Carrier is a
, ✔✔Remittance Advice (RA)- A letter sent to a patient from insurance provider stating
that their invoice is paid - ✔✔When send a claim to a 2nd payer you need to send a
copy of
✔✔Contractual allowance- difference between what hospitals bill and what they receive
in payment from 3rd Party Payers - ✔✔Remark code from a EOB document-(EOB)-
statement sent by a health insurance company covered individual explaining what
medical treatments and/ or services were paid for on their behalf
✔✔Professional component- Provided by a physician, may include supervision,
interpretation, and writer report - ✔✔CPT code used to indicate provider supervised and
interpreted
✔✔Informed consent - ✔✔Providers explain medical or diagnostic procedures, surgical
interventions, and the benefits and risks involved, giving the patients opportunity to ask
questions before medical intervention is provided. Signature is required
✔✔Implied consent - ✔✔A patient presents for treatment, such as extending an arm to
all venipuncture to be performed. Signature is NOT required
✔✔Clearinghouse - ✔✔Agency, that converts claims into standardized electronic
format, looks for errors, and formats them according to HIPPA and insurance standards
✔✔De- identifiable information - ✔✔Information that does not identify and individual
because unique and personal characteristics have been removed
✔✔Consent - ✔✔A patients permission evidenced by signature
✔✔Authorization - ✔✔Permission granted by the patient or the patients representative
to release information for reasons other than treatment, payment, or health care
operations
✔✔Reimbursment - ✔✔Payment for services rendered from a 3rd Party Payer
✔✔Auditing - ✔✔Review of claims for accuracy and completeness
✔✔Upcoding - ✔✔Assigning a diagnosis or procedure code at a higher level than the
documentation supports, such as single code that describes all steps of the procedure
✔✔Unbundling - ✔✔Using multiple codes that describe different components of a
treatment instead of using a single code that describes all steps of the procedure
EXAM QUESTIONS AND ANSWERS RATED A+
✔✔(RAC) Recovery audit Contractor - ✔✔Which of the following organizations identifies
improper payments made on CMS claims
✔✔Bone and bone marrow - ✔✔IF a patient has osteomyelitis he has problems with
which of the following areas?
✔✔Preauthorization form - ✔✔Which of the following is a requirement of some third-
party payers before a procedure is performed?
✔✔Precertification - ✔✔Ensure appropriate insurance coverage for an outpatient
procedure by first using the following process
✔✔History - ✔✔Key component if an evaluation and management service
✔✔837 - ✔✔Format used to submit electronic claims and 3rd Party payer
✔✔Office of the Inspector General (OIG) - ✔✔Entity that defines the essential element
of a comprehensive compliance program
✔✔National Coverage Determination - ✔✔Medicare Policy determines if a particular
item or service is covered
✔✔Left upper quadrant - ✔✔Location of the stomach, spleen, part of the pancreas and
liver
✔✔18% - ✔✔Coding a front torso burn, what % should be used?
✔✔An italicized code used as the 1st listed diagnosis - ✔✔Result of a claim being
denied
✔✔Charging excessive fees - ✔✔Example of Medicare abuse
✔✔Codes must correspond to the diagnosis pointer in block 24E - ✔✔Diagnostic codes
in Block 21 of the CMS form
✔✔(S) Subjective - ✔✔Soap note to indicate patient level of pain to provider
✔✔HIPPA Standard transaction - ✔✔Standardized format used in electronic filing of
claims
✔✔3rd Party Payer - ✔✔Insurance Carrier is a
, ✔✔Remittance Advice (RA)- A letter sent to a patient from insurance provider stating
that their invoice is paid - ✔✔When send a claim to a 2nd payer you need to send a
copy of
✔✔Contractual allowance- difference between what hospitals bill and what they receive
in payment from 3rd Party Payers - ✔✔Remark code from a EOB document-(EOB)-
statement sent by a health insurance company covered individual explaining what
medical treatments and/ or services were paid for on their behalf
✔✔Professional component- Provided by a physician, may include supervision,
interpretation, and writer report - ✔✔CPT code used to indicate provider supervised and
interpreted
✔✔Informed consent - ✔✔Providers explain medical or diagnostic procedures, surgical
interventions, and the benefits and risks involved, giving the patients opportunity to ask
questions before medical intervention is provided. Signature is required
✔✔Implied consent - ✔✔A patient presents for treatment, such as extending an arm to
all venipuncture to be performed. Signature is NOT required
✔✔Clearinghouse - ✔✔Agency, that converts claims into standardized electronic
format, looks for errors, and formats them according to HIPPA and insurance standards
✔✔De- identifiable information - ✔✔Information that does not identify and individual
because unique and personal characteristics have been removed
✔✔Consent - ✔✔A patients permission evidenced by signature
✔✔Authorization - ✔✔Permission granted by the patient or the patients representative
to release information for reasons other than treatment, payment, or health care
operations
✔✔Reimbursment - ✔✔Payment for services rendered from a 3rd Party Payer
✔✔Auditing - ✔✔Review of claims for accuracy and completeness
✔✔Upcoding - ✔✔Assigning a diagnosis or procedure code at a higher level than the
documentation supports, such as single code that describes all steps of the procedure
✔✔Unbundling - ✔✔Using multiple codes that describe different components of a
treatment instead of using a single code that describes all steps of the procedure
