Medical Coding Exam 39&40
Questions and Answers | Latest
Version | 2025/2026 | Correct & Verified
What is the main purpose of medical insurance?
✔✔To protect patients and providers from high healthcare costs.
What is a deductible in medical insurance?
✔✔The amount a patient must pay before the insurance begins to cover services.
What is a copayment?
✔✔A fixed amount a patient pays at the time of service.
What is coinsurance?
✔✔A percentage of medical costs that the patient must pay after the deductible is met.
What is an insurance premium?
✔✔The regular payment made to maintain health insurance coverage.
1
,What is a preauthorization in insurance?
✔✔Approval from an insurance company before certain services are provided.
What is the purpose of coordination of benefits?
✔✔To determine which insurance plan pays first when a patient has multiple plans.
What is an out-of-pocket maximum?
✔✔The highest amount a patient must pay for covered services in a year.
What does the term “in-network” mean?
✔✔Healthcare providers who have agreed to contracted rates with an insurance company.
What does “out-of-network” mean?
✔✔Providers who do not have a contract with the insurance company.
What is a claim in medical insurance?
✔✔A request for payment submitted to an insurance company for healthcare services.
2
, What is a rejected claim?
✔✔A claim that is not processed due to errors or missing information.
What is a denied claim?
✔✔A claim that has been processed but not approved for payment.
What is an explanation of benefits (EOB)?
✔✔A document from the insurer detailing what was paid and what the patient owes.
What is a policyholder?
✔✔The person who owns or subscribes to an insurance policy.
What is a beneficiary?
✔✔The person who receives benefits from an insurance policy.
What is the difference between Medicaid and Medicare?
✔✔Medicaid assists low-income individuals, while Medicare serves people 65 and older or
disabled.
3
Questions and Answers | Latest
Version | 2025/2026 | Correct & Verified
What is the main purpose of medical insurance?
✔✔To protect patients and providers from high healthcare costs.
What is a deductible in medical insurance?
✔✔The amount a patient must pay before the insurance begins to cover services.
What is a copayment?
✔✔A fixed amount a patient pays at the time of service.
What is coinsurance?
✔✔A percentage of medical costs that the patient must pay after the deductible is met.
What is an insurance premium?
✔✔The regular payment made to maintain health insurance coverage.
1
,What is a preauthorization in insurance?
✔✔Approval from an insurance company before certain services are provided.
What is the purpose of coordination of benefits?
✔✔To determine which insurance plan pays first when a patient has multiple plans.
What is an out-of-pocket maximum?
✔✔The highest amount a patient must pay for covered services in a year.
What does the term “in-network” mean?
✔✔Healthcare providers who have agreed to contracted rates with an insurance company.
What does “out-of-network” mean?
✔✔Providers who do not have a contract with the insurance company.
What is a claim in medical insurance?
✔✔A request for payment submitted to an insurance company for healthcare services.
2
, What is a rejected claim?
✔✔A claim that is not processed due to errors or missing information.
What is a denied claim?
✔✔A claim that has been processed but not approved for payment.
What is an explanation of benefits (EOB)?
✔✔A document from the insurer detailing what was paid and what the patient owes.
What is a policyholder?
✔✔The person who owns or subscribes to an insurance policy.
What is a beneficiary?
✔✔The person who receives benefits from an insurance policy.
What is the difference between Medicaid and Medicare?
✔✔Medicaid assists low-income individuals, while Medicare serves people 65 and older or
disabled.
3
