Medical Billing and Coding Prac ce EXAM| MOSTLY
TESTED COMPLETE QUESTIONS AND ANSWERS | 2025
LATEST UPDATED | GET IT CORRECT!!
What type of insurance allows treatment virtually anywhere with a high deduc ble that
policyholder are willing to pay? - Ans PPO
Veterans with service related disabili es are eligible for care under which of the following
programs: - Ans CHAMPVA
______________________ is usually sponsored and par ally paid by an employer - Ans Group
Health Insurance
______________________ are used to report encounter for circumstances other than a
disease or injury in ICD-10-CM - Ans Z codes
The abbrevia on PMPM stand for - Ans Per member per month
Schedule of benefits means: - Ans Medical service covered under the insured's policy
Medicare is funded by - Ans Federal funds
Physician's establish a list of their usual fees for? - Ans 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 - Ans Allowed amount
, Which of the following statements is true under the doctrine of respondeat superior? - Ans The
physician is responsible for any errors made by the medical staff
HIPAA stands for which of the following? - Ans Health Insurance Portability and Accountability
Act
Informa on given by a pa ent to medical personnel that cannot be disclosed without consent
cons tutes - Ans Privileged communica on
Why is a superbill/encounter form an important document in the office? - Ans It ensures the
correct pa ent data informa on and procedure codes
Which of the following facili es does not use CMS-1500 forms? - Ans Acute care
Physicians usually submit claims for pa ents and receive payments directly from the payers.
The policy holder authorized this by signing and da ng a: - Ans Assignment of benefits
Under the HIPAA Privacy Rule, providers do not need specific authoriza on in order to release a
pa ent's PHI for TPO purposes. What does TPO stand for? - Ans Treatment, payment and health
care opera ons
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? - Ans The parent whose
birthday is earlier in the calendar year is the primary
There are three par cipants in the medical insurance rela onship the first party, the second
party and the third party. Who is referred to as the second party? - Ans Physician
TESTED COMPLETE QUESTIONS AND ANSWERS | 2025
LATEST UPDATED | GET IT CORRECT!!
What type of insurance allows treatment virtually anywhere with a high deduc ble that
policyholder are willing to pay? - Ans PPO
Veterans with service related disabili es are eligible for care under which of the following
programs: - Ans CHAMPVA
______________________ is usually sponsored and par ally paid by an employer - Ans Group
Health Insurance
______________________ are used to report encounter for circumstances other than a
disease or injury in ICD-10-CM - Ans Z codes
The abbrevia on PMPM stand for - Ans Per member per month
Schedule of benefits means: - Ans Medical service covered under the insured's policy
Medicare is funded by - Ans Federal funds
Physician's establish a list of their usual fees for? - Ans 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 - Ans Allowed amount
, Which of the following statements is true under the doctrine of respondeat superior? - Ans The
physician is responsible for any errors made by the medical staff
HIPAA stands for which of the following? - Ans Health Insurance Portability and Accountability
Act
Informa on given by a pa ent to medical personnel that cannot be disclosed without consent
cons tutes - Ans Privileged communica on
Why is a superbill/encounter form an important document in the office? - Ans It ensures the
correct pa ent data informa on and procedure codes
Which of the following facili es does not use CMS-1500 forms? - Ans Acute care
Physicians usually submit claims for pa ents and receive payments directly from the payers.
The policy holder authorized this by signing and da ng a: - Ans Assignment of benefits
Under the HIPAA Privacy Rule, providers do not need specific authoriza on in order to release a
pa ent's PHI for TPO purposes. What does TPO stand for? - Ans Treatment, payment and health
care opera ons
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? - Ans The parent whose
birthday is earlier in the calendar year is the primary
There are three par cipants in the medical insurance rela onship the first party, the second
party and the third party. Who is referred to as the second party? - Ans Physician
