CMS Billing, Coding & Reimbursement Compliance Exam
| Complete Question Bank & Practice Questions
(2026/2027)
Question 1
What is the primary purpose of the False Claims Act (FCA) in
healthcare?
A. To allow hospitals to overcharge for services to cover overhead.
B. To impose liability on persons and companies (typically federal
contractors) that defraud governmental programs.
C. To streamline the billing process for private insurance companies.
D. To regulate the salary of hospital coders.
Correct Answer: B. To impose liability on persons and companies
(typically federal contractors) that defraud governmental programs.
,Detailed Rationale: The False Claims Act is the government’s primary
litigation tool for recovering losses from fraud, such as billing for
services not provided or upcoding.
Question 2
What is "Unbundling" in medical coding?
A. A legal practice of combining codes to save money.
B. The practice of using a single comprehensive code when several
separate codes are more appropriate.
C. The illegal practice of billing separate component codes for a
procedure that should be billed under a single, comprehensive code.
D. A method of organizing medical records chronologically.
Correct Answer: C. The illegal practice of billing separate component
codes for a procedure that should be billed under a single,
comprehensive code.
, Detailed Rationale: Unbundling is a common compliance violation
designed to inflate reimbursement by fragmenting services that should
be bundled.
Question 3
What does "Medical Necessity" mean in the context of Medicare
billing?
A. The doctor's opinion that a service is "nice to have."
B. The specific requirement that a service or item must be reasonable
and necessary for the diagnosis or treatment of illness or injury.
C. The ability of the hospital to afford the equipment used.
D. The patient's desire to have a specific test performed.
Correct Answer: B. The specific requirement that a service or item must
be reasonable and necessary for the diagnosis or treatment of illness or
injury.
| Complete Question Bank & Practice Questions
(2026/2027)
Question 1
What is the primary purpose of the False Claims Act (FCA) in
healthcare?
A. To allow hospitals to overcharge for services to cover overhead.
B. To impose liability on persons and companies (typically federal
contractors) that defraud governmental programs.
C. To streamline the billing process for private insurance companies.
D. To regulate the salary of hospital coders.
Correct Answer: B. To impose liability on persons and companies
(typically federal contractors) that defraud governmental programs.
,Detailed Rationale: The False Claims Act is the government’s primary
litigation tool for recovering losses from fraud, such as billing for
services not provided or upcoding.
Question 2
What is "Unbundling" in medical coding?
A. A legal practice of combining codes to save money.
B. The practice of using a single comprehensive code when several
separate codes are more appropriate.
C. The illegal practice of billing separate component codes for a
procedure that should be billed under a single, comprehensive code.
D. A method of organizing medical records chronologically.
Correct Answer: C. The illegal practice of billing separate component
codes for a procedure that should be billed under a single,
comprehensive code.
, Detailed Rationale: Unbundling is a common compliance violation
designed to inflate reimbursement by fragmenting services that should
be bundled.
Question 3
What does "Medical Necessity" mean in the context of Medicare
billing?
A. The doctor's opinion that a service is "nice to have."
B. The specific requirement that a service or item must be reasonable
and necessary for the diagnosis or treatment of illness or injury.
C. The ability of the hospital to afford the equipment used.
D. The patient's desire to have a specific test performed.
Correct Answer: B. The specific requirement that a service or item must
be reasonable and necessary for the diagnosis or treatment of illness or
injury.
