Medical Billing and Coding Practice EXAM| MOSTLY TESTED COMPLETE
在中文中
QUESTIONS AND ANSWERS | 2025 LATEST UPDATED | GET IT CORRECT!!
What type of insurance allows treatment virtually anywhere with a high deductible that policyholder are
willing to pay? - (ANSWER)PPO
Veterans with service related disabilities are eligible for care under which of the following programs: -
(ANSWER)CHAMPVA
______________________ is usually sponsored and partially paid by an employer - (ANSWER)Group
Health Insurance
______________________ are used to report encounter for circumstances other than a disease or injury
in ICD-10-CM - (ANSWER)Z codes
The abbreviation PMPM stand for - (ANSWER)Per member per month
Schedule of benefits means: - (ANSWER)Medical service covered under the insured's policy
Medicare is funded by - (ANSWER)Federal funds
Physician's establish a list of their usual fees for? - (ANSWER)The procedures and services they
frequently perform
The insurance carrier is allowed to use any method to determine the amount for a service, also known as
th - (ANSWER)Allowed amount
Which of the following statements is true under the doctrine of respondeat superior? - (ANSWER)The
physician is responsible for any errors made by the medical staff
HIPAA stands for which of the following? - (ANSWER)Health Insurance Portability and Accountability
Act
, Information given by a patient to medical personnel that cannot be disclosed without consent constitutes -
(ANSWER)Privileged communication 在中文中
Why is a superbill/encounter form an important document in the office? - (ANSWER)It ensures the
correct patient data information and procedure codes
Which of the following facilities does not use CMS-1500 forms? - (ANSWER)Acute care
Physicians usually submit claims for patients and receive payments directly from the payers. The policy
holder authorized this by signing and dating a: - (ANSWER)Assignment of benefits
Under the HIPAA Privacy Rule, providers do not need specific authorization in order to release a patient's
PHI for TPO purposes. What does TPO stand for? - (ANSWER)Treatment, payment and health care
operations
If both parents cover dependents on their plan, the child's primary insurance is usually determined by the
birthday rule. What is meant by the birthday rule? - (ANSWER)The parent whose birthday is earlier in
the calendar year is the primary
There are three participants in the medical insurance relationship the first party, the second party and the
third party. Who is referred to as the second party? - (ANSWER)Physician
Co-insurance is calculated based on: - (ANSWER)A percentage of a charge
If a health plan member received medical services from a provider who does not participate in the plan,
the cost for the member is typically: - (ANSWER)Higher
The tertiary insurance pays - (ANSWER)after the first and second payers
A certification number for a procedure is the result of which transaction and process? -
(ANSWER)Referral and authorization
Which of the following is one of the section in the CPT Coding Manual - (ANSWER)Pathology and
Laboratory
在中文中
QUESTIONS AND ANSWERS | 2025 LATEST UPDATED | GET IT CORRECT!!
What type of insurance allows treatment virtually anywhere with a high deductible that policyholder are
willing to pay? - (ANSWER)PPO
Veterans with service related disabilities are eligible for care under which of the following programs: -
(ANSWER)CHAMPVA
______________________ is usually sponsored and partially paid by an employer - (ANSWER)Group
Health Insurance
______________________ are used to report encounter for circumstances other than a disease or injury
in ICD-10-CM - (ANSWER)Z codes
The abbreviation PMPM stand for - (ANSWER)Per member per month
Schedule of benefits means: - (ANSWER)Medical service covered under the insured's policy
Medicare is funded by - (ANSWER)Federal funds
Physician's establish a list of their usual fees for? - (ANSWER)The procedures and services they
frequently perform
The insurance carrier is allowed to use any method to determine the amount for a service, also known as
th - (ANSWER)Allowed amount
Which of the following statements is true under the doctrine of respondeat superior? - (ANSWER)The
physician is responsible for any errors made by the medical staff
HIPAA stands for which of the following? - (ANSWER)Health Insurance Portability and Accountability
Act
, Information given by a patient to medical personnel that cannot be disclosed without consent constitutes -
(ANSWER)Privileged communication 在中文中
Why is a superbill/encounter form an important document in the office? - (ANSWER)It ensures the
correct patient data information and procedure codes
Which of the following facilities does not use CMS-1500 forms? - (ANSWER)Acute care
Physicians usually submit claims for patients and receive payments directly from the payers. The policy
holder authorized this by signing and dating a: - (ANSWER)Assignment of benefits
Under the HIPAA Privacy Rule, providers do not need specific authorization in order to release a patient's
PHI for TPO purposes. What does TPO stand for? - (ANSWER)Treatment, payment and health care
operations
If both parents cover dependents on their plan, the child's primary insurance is usually determined by the
birthday rule. What is meant by the birthday rule? - (ANSWER)The parent whose birthday is earlier in
the calendar year is the primary
There are three participants in the medical insurance relationship the first party, the second party and the
third party. Who is referred to as the second party? - (ANSWER)Physician
Co-insurance is calculated based on: - (ANSWER)A percentage of a charge
If a health plan member received medical services from a provider who does not participate in the plan,
the cost for the member is typically: - (ANSWER)Higher
The tertiary insurance pays - (ANSWER)after the first and second payers
A certification number for a procedure is the result of which transaction and process? -
(ANSWER)Referral and authorization
Which of the following is one of the section in the CPT Coding Manual - (ANSWER)Pathology and
Laboratory
