Medical Billing and Coding Chapters
1-3 Exam Questions and Answers
(Latest Update 2026)
Health Insurance Claims -
correct answer ✅Documentation submitted to an insurance plan
requesting reimbursement for healthcare services provided.
Hold harmless clause -
correct answer ✅Policy that the patient is not responsible for
paying what the insurance plan denies.
Balance billing clause -
correct answer ✅Billing beneficiaries for amounts not reimbursed
by payers (not including copayments and coinsurance amounts):
this practice is prohibited by Medicare regulations.
Healthcare provider -
correct answer ✅Physician or other health care practitioner.
Centers for Medicare and Medicaid Services CMS -
correct answer ✅Formerly known as the Health Care Financing
Administration (HCFA); an administrative agency within the Federal
Department of Health and Human Services (DHHS)
, Medical Billing and Coding Chapters
1-3 Exam Questions and Answers
(Latest Update 2026)
Medical necessity -
correct answer ✅Involves linking every procedure or service code
reported on an insurance claim to a condition code (e.g., disease,
injury, sign, symptom, other reasons for encounter) that justifies
the need to perform that procedure or service
CMS - 1500 -
correct answer ✅Form used to submit Medicare claims; previously
called the HCFA - 1500
CPT codes -
correct answer ✅A 5 digit numeric code that is used to describe
medical, surgical, radiology laboratory, anesthesiology, and
evaluation / management services of physicians, hospitals, and
other care providers.
ICD - 9 codes -
correct answer ✅A standardized classification of disease, injuries,
and causes of death by etiology and localization and codified into a
6 digit number, which allows clinicians, statistician, politicians,
health planners and others to speak a common language.
1-3 Exam Questions and Answers
(Latest Update 2026)
Health Insurance Claims -
correct answer ✅Documentation submitted to an insurance plan
requesting reimbursement for healthcare services provided.
Hold harmless clause -
correct answer ✅Policy that the patient is not responsible for
paying what the insurance plan denies.
Balance billing clause -
correct answer ✅Billing beneficiaries for amounts not reimbursed
by payers (not including copayments and coinsurance amounts):
this practice is prohibited by Medicare regulations.
Healthcare provider -
correct answer ✅Physician or other health care practitioner.
Centers for Medicare and Medicaid Services CMS -
correct answer ✅Formerly known as the Health Care Financing
Administration (HCFA); an administrative agency within the Federal
Department of Health and Human Services (DHHS)
, Medical Billing and Coding Chapters
1-3 Exam Questions and Answers
(Latest Update 2026)
Medical necessity -
correct answer ✅Involves linking every procedure or service code
reported on an insurance claim to a condition code (e.g., disease,
injury, sign, symptom, other reasons for encounter) that justifies
the need to perform that procedure or service
CMS - 1500 -
correct answer ✅Form used to submit Medicare claims; previously
called the HCFA - 1500
CPT codes -
correct answer ✅A 5 digit numeric code that is used to describe
medical, surgical, radiology laboratory, anesthesiology, and
evaluation / management services of physicians, hospitals, and
other care providers.
ICD - 9 codes -
correct answer ✅A standardized classification of disease, injuries,
and causes of death by etiology and localization and codified into a
6 digit number, which allows clinicians, statistician, politicians,
health planners and others to speak a common language.
