CERTIFIED BILLING AND CODING TEST PAPER 2025/2026
QUESTIONS WITH ANSWERS TAGGED A+
✔✔What does the term "crossover" as it relates to Medicare mean? - ✔✔When an
insurance company transfers data to allow the coordination of benefits of a claim
✔✔The __________ symbol is used to indicate new and revised text other than the
procedure descriptors. - ✔✔><
✔✔For a non-crossover claim, the billing and coding specialist should prepare an
additional claim for the secondary payer and send it with a copy of
________________________. - ✔✔Remittance advice
✔✔Osteo means - ✔✔bones
✔✔Myel means - ✔✔bone marrow
✔✔What does a lightning bolt symbol found in the CPT manual mean? - ✔✔A product
pending FDA approval
✔✔A prospective billing account audit prevents fraud by reviewing and comparing a
completed claim form with which of the following document? - ✔✔A billing worksheet
from the patient's account
✔✔The ICD 10-CM manual states that if the same condition is described as both acute
and chronic to code both, which is sequence first? - ✔✔acute
✔✔Medicare _______________ will trigger a claim rejection for improper code
combinations. - ✔✔NCCI edits
✔✔The billing and coding specialist should submit a paper form if the claim requires an
__________________. - ✔✔attachment
✔✔A ______________________ is an independent organization that receives
insurance claims from a physician's offices, performs software edits, and distributes
those claims. - ✔✔clearinghouse
✔✔A billing and coding specialist should use _________________________ for paper
claims. - ✔✔Arial, Pica or OCR 10, 11, or 12 point font
✔✔Why is it important to verify insurance? - ✔✔To ensure that the insurance is valid
and the services are a covered benefit.
, ✔✔What are the three main kinds of government insurance plans? - ✔✔Medicare,
Medicaid and State Children's Health Insurance (SCHIP)
✔✔Which block on the CMS-1500 is used to enter the secondary insurance? - ✔✔9a
✔✔The date of the last disclosure is required to be included in the release of patient
information.
True or False - ✔✔True
✔✔CMS-1500 form can be converted to _____________________________. - ✔✔837
format
✔✔Why is the item 11 on the CMS-1500 form important? - ✔✔This is the place to
indicate that a good faith effort had been made to determine which is the primary
insurance and which is the secondary.
✔✔A _____________ is a complete record of all the services provided to the patient. -
✔✔claim
✔✔Describe when Medicare is the secondary insurance for a patient. - ✔✔Medicare is
secondary insurance to the patient when patient has group health insurance, is covered
by workers' compensation, or in on disability.
✔✔By signing block 12 on the CMS-1500 form, a patient is doing which of the
following?
a) Authorizing the release of funds to a provider
b) Authorizing the provider to perform a procedure
c) Authorizing the release of medical information needed to process a claim
d) Authorizing hospice care - ✔✔Authorizing the release of medical information needed
to process a claim.
✔✔What is preauthorization? - ✔✔Is approval from the health plan for an inpatient
hospital stay or surgery.
✔✔What is predetermination? - ✔✔A written request for a verification of benefits.
✔✔What is precertification? - ✔✔A review that looks at whether the procedure could be
performed safely but less expensively in an outpatient setting.
✔✔What are CPT modifiers? - ✔✔place of service
✔✔What does CPT mean? - ✔✔Current Procedural Terminology
QUESTIONS WITH ANSWERS TAGGED A+
✔✔What does the term "crossover" as it relates to Medicare mean? - ✔✔When an
insurance company transfers data to allow the coordination of benefits of a claim
✔✔The __________ symbol is used to indicate new and revised text other than the
procedure descriptors. - ✔✔><
✔✔For a non-crossover claim, the billing and coding specialist should prepare an
additional claim for the secondary payer and send it with a copy of
________________________. - ✔✔Remittance advice
✔✔Osteo means - ✔✔bones
✔✔Myel means - ✔✔bone marrow
✔✔What does a lightning bolt symbol found in the CPT manual mean? - ✔✔A product
pending FDA approval
✔✔A prospective billing account audit prevents fraud by reviewing and comparing a
completed claim form with which of the following document? - ✔✔A billing worksheet
from the patient's account
✔✔The ICD 10-CM manual states that if the same condition is described as both acute
and chronic to code both, which is sequence first? - ✔✔acute
✔✔Medicare _______________ will trigger a claim rejection for improper code
combinations. - ✔✔NCCI edits
✔✔The billing and coding specialist should submit a paper form if the claim requires an
__________________. - ✔✔attachment
✔✔A ______________________ is an independent organization that receives
insurance claims from a physician's offices, performs software edits, and distributes
those claims. - ✔✔clearinghouse
✔✔A billing and coding specialist should use _________________________ for paper
claims. - ✔✔Arial, Pica or OCR 10, 11, or 12 point font
✔✔Why is it important to verify insurance? - ✔✔To ensure that the insurance is valid
and the services are a covered benefit.
, ✔✔What are the three main kinds of government insurance plans? - ✔✔Medicare,
Medicaid and State Children's Health Insurance (SCHIP)
✔✔Which block on the CMS-1500 is used to enter the secondary insurance? - ✔✔9a
✔✔The date of the last disclosure is required to be included in the release of patient
information.
True or False - ✔✔True
✔✔CMS-1500 form can be converted to _____________________________. - ✔✔837
format
✔✔Why is the item 11 on the CMS-1500 form important? - ✔✔This is the place to
indicate that a good faith effort had been made to determine which is the primary
insurance and which is the secondary.
✔✔A _____________ is a complete record of all the services provided to the patient. -
✔✔claim
✔✔Describe when Medicare is the secondary insurance for a patient. - ✔✔Medicare is
secondary insurance to the patient when patient has group health insurance, is covered
by workers' compensation, or in on disability.
✔✔By signing block 12 on the CMS-1500 form, a patient is doing which of the
following?
a) Authorizing the release of funds to a provider
b) Authorizing the provider to perform a procedure
c) Authorizing the release of medical information needed to process a claim
d) Authorizing hospice care - ✔✔Authorizing the release of medical information needed
to process a claim.
✔✔What is preauthorization? - ✔✔Is approval from the health plan for an inpatient
hospital stay or surgery.
✔✔What is predetermination? - ✔✔A written request for a verification of benefits.
✔✔What is precertification? - ✔✔A review that looks at whether the procedure could be
performed safely but less expensively in an outpatient setting.
✔✔What are CPT modifiers? - ✔✔place of service
✔✔What does CPT mean? - ✔✔Current Procedural Terminology
