Medical Coding and Billing
Certification (MCBC) Study Guide I
Questions and Answers | Latest
Version | 2025/2026 | Correct & Verified
What is the role of a medical coder?
✔✔To translate medical diagnoses, procedures, and services into standardized codes for billing.
What coding system is used for outpatient diagnoses?
✔✔ICD-10-CM.
What coding system is used for medical procedures and services?
✔✔CPT (Current Procedural Terminology).
What is the claim form used by physicians to bill for professional services?
✔✔CMS-1500 form.
What is the claim form used by hospitals for inpatient services?
✔✔UB-04 form.
1
,What does HIPAA stand for?
✔✔Health Insurance Portability and Accountability Act.
What is the main goal of HIPAA?
✔✔To protect patient health information and ensure privacy.
What is medical necessity?
✔✔Services or procedures that are needed for diagnosis or treatment and are consistent with
accepted standards of practice.
What does EOB stand for?
✔✔Explanation of Benefits.
What is the purpose of an EOB?
✔✔To explain how and why an insurance claim was paid, adjusted, or denied.
What is a deductible in medical insurance?
2
, ✔✔The amount a patient must pay out of pocket before insurance begins to cover services.
What is a copayment?
✔✔A fixed amount a patient pays for a covered service at the time of care.
What is coinsurance?
✔✔The percentage of costs a patient pays after the deductible is met.
What is a superbill used for in medical billing?
✔✔To record services provided and the corresponding diagnosis and procedure codes.
What is upcoding?
✔✔Assigning a higher-level code than appropriate to receive more payment.
What is downcoding?
✔✔Assigning a lower-level code that results in underpayment for a service.
What is unbundling in medical coding?
3
Certification (MCBC) Study Guide I
Questions and Answers | Latest
Version | 2025/2026 | Correct & Verified
What is the role of a medical coder?
✔✔To translate medical diagnoses, procedures, and services into standardized codes for billing.
What coding system is used for outpatient diagnoses?
✔✔ICD-10-CM.
What coding system is used for medical procedures and services?
✔✔CPT (Current Procedural Terminology).
What is the claim form used by physicians to bill for professional services?
✔✔CMS-1500 form.
What is the claim form used by hospitals for inpatient services?
✔✔UB-04 form.
1
,What does HIPAA stand for?
✔✔Health Insurance Portability and Accountability Act.
What is the main goal of HIPAA?
✔✔To protect patient health information and ensure privacy.
What is medical necessity?
✔✔Services or procedures that are needed for diagnosis or treatment and are consistent with
accepted standards of practice.
What does EOB stand for?
✔✔Explanation of Benefits.
What is the purpose of an EOB?
✔✔To explain how and why an insurance claim was paid, adjusted, or denied.
What is a deductible in medical insurance?
2
, ✔✔The amount a patient must pay out of pocket before insurance begins to cover services.
What is a copayment?
✔✔A fixed amount a patient pays for a covered service at the time of care.
What is coinsurance?
✔✔The percentage of costs a patient pays after the deductible is met.
What is a superbill used for in medical billing?
✔✔To record services provided and the corresponding diagnosis and procedure codes.
What is upcoding?
✔✔Assigning a higher-level code than appropriate to receive more payment.
What is downcoding?
✔✔Assigning a lower-level code that results in underpayment for a service.
What is unbundling in medical coding?
3
