NCCT Insurance & Coding Practice
Test| 125 questions| with
complete solutions
Course
NCCT Insurance & Coding
Question 1
Which code set is primarily used to report physician services and outpatient procedures?
A. ICD-10-CM
B. HCPCS Level II
C. CPT
D. DRG
Correct Answer: C. CPT
Solution:
Current Procedural Terminology (CPT) codes describe medical, surgical, and diagnostic
procedures performed by healthcare providers. CPT is the standard code set for physician and
outpatient services.
ICD-10-CM = Diagnoses
HCPCS Level II = Supplies, ambulance services, and certain medications
DRGs = Hospital inpatient payment classification
Question 2
A patient is covered under two health insurance policies. Which process determines which
insurance pays first?
A. Preauthorization
B. Coordination of Benefits (COB)
C. Remittance Advice
D. Capitation
Correct Answer: B. Coordination of Benefits (COB)
Solution:
Coordination of Benefits (COB) establishes the order in which multiple insurance plans pay
claims, preventing duplicate payment and ensuring accurate reimbursement.
,Question 3
What does ICD-10-CM primarily classify?
A. Medical procedures
B. Diagnoses and health conditions
C. Medical equipment
D. Insurance plans
Correct Answer: B. Diagnoses and health conditions
Solution:
ICD-10-CM codes represent diseases, injuries, symptoms, and other medical conditions that
justify the medical necessity of services.
Question 4
A deductible is best defined as:
A. The amount the insurance company pays after the claim
B. The fixed amount paid for every office visit
C. The amount the patient must pay before insurance begins covering eligible services
D. A penalty charged for late claims
Correct Answer: C. The amount the patient must pay before insurance begins covering eligible
services
Solution:
A deductible is the patient's annual financial responsibility before insurance begins paying
covered healthcare expenses, except for services exempt from the deductible.
Question 5
Which claim form is commonly used for professional healthcare services?
A. UB-04 (CMS-1450)
B. CMS-1500
C. Explanation of Benefits
D. Prior Authorization Form
Correct Answer: B. CMS-1500
,Solution:
The CMS-1500 form is used by physicians and other healthcare professionals to submit claims
for outpatient and professional services.
Question 6
The purpose of an Explanation of Benefits (EOB) is to:
A. Bill the patient directly
B. Explain how an insurance claim was processed
C. Request prior authorization
D. Verify patient eligibility
Correct Answer: B. Explain how an insurance claim was processed
Solution:
An EOB summarizes:
Services billed
Amount charged
Insurance payment
Patient responsibility
Reasons for denials or adjustments
It is not a bill.
Question 7
Which organization maintains the CPT coding system?
A. CMS
B. CDC
C. American Medical Association (AMA)
D. OSHA
Correct Answer: C. American Medical Association (AMA)
Solution:
The AMA publishes and updates CPT codes annually to reflect changes in medical procedures
and technology.
, Question 8
Which modifier indicates that a separately identifiable Evaluation and Management (E/M)
service was performed on the same day as another procedure?
A. Modifier 22
B. Modifier 25
C. Modifier 59
D. Modifier 76
Correct Answer: B. Modifier 25
Solution:
Modifier 25 informs the payer that the provider performed a significant, separately identifiable
E/M service in addition to another procedure on the same date.
Question 9
A clean claim is one that:
A. Requires additional documentation
B. Contains complete and accurate information for processing
C. Is submitted on paper only
D. Has already been paid
Correct Answer: B. Contains complete and accurate information for processing
Solution:
A clean claim includes all required patient, provider, diagnosis, and procedure information,
allowing the insurance company to process it without requesting corrections.
Question 10
Which insurance plan generally requires members to select a primary care provider (PCP)?
A. PPO
B. HMO
C. Indemnity Plan
D. POS without PCP
Correct Answer: B. HMO
Solution:
Health Maintenance Organizations (HMOs) typically require members to:
Test| 125 questions| with
complete solutions
Course
NCCT Insurance & Coding
Question 1
Which code set is primarily used to report physician services and outpatient procedures?
A. ICD-10-CM
B. HCPCS Level II
C. CPT
D. DRG
Correct Answer: C. CPT
Solution:
Current Procedural Terminology (CPT) codes describe medical, surgical, and diagnostic
procedures performed by healthcare providers. CPT is the standard code set for physician and
outpatient services.
ICD-10-CM = Diagnoses
HCPCS Level II = Supplies, ambulance services, and certain medications
DRGs = Hospital inpatient payment classification
Question 2
A patient is covered under two health insurance policies. Which process determines which
insurance pays first?
A. Preauthorization
B. Coordination of Benefits (COB)
C. Remittance Advice
D. Capitation
Correct Answer: B. Coordination of Benefits (COB)
Solution:
Coordination of Benefits (COB) establishes the order in which multiple insurance plans pay
claims, preventing duplicate payment and ensuring accurate reimbursement.
,Question 3
What does ICD-10-CM primarily classify?
A. Medical procedures
B. Diagnoses and health conditions
C. Medical equipment
D. Insurance plans
Correct Answer: B. Diagnoses and health conditions
Solution:
ICD-10-CM codes represent diseases, injuries, symptoms, and other medical conditions that
justify the medical necessity of services.
Question 4
A deductible is best defined as:
A. The amount the insurance company pays after the claim
B. The fixed amount paid for every office visit
C. The amount the patient must pay before insurance begins covering eligible services
D. A penalty charged for late claims
Correct Answer: C. The amount the patient must pay before insurance begins covering eligible
services
Solution:
A deductible is the patient's annual financial responsibility before insurance begins paying
covered healthcare expenses, except for services exempt from the deductible.
Question 5
Which claim form is commonly used for professional healthcare services?
A. UB-04 (CMS-1450)
B. CMS-1500
C. Explanation of Benefits
D. Prior Authorization Form
Correct Answer: B. CMS-1500
,Solution:
The CMS-1500 form is used by physicians and other healthcare professionals to submit claims
for outpatient and professional services.
Question 6
The purpose of an Explanation of Benefits (EOB) is to:
A. Bill the patient directly
B. Explain how an insurance claim was processed
C. Request prior authorization
D. Verify patient eligibility
Correct Answer: B. Explain how an insurance claim was processed
Solution:
An EOB summarizes:
Services billed
Amount charged
Insurance payment
Patient responsibility
Reasons for denials or adjustments
It is not a bill.
Question 7
Which organization maintains the CPT coding system?
A. CMS
B. CDC
C. American Medical Association (AMA)
D. OSHA
Correct Answer: C. American Medical Association (AMA)
Solution:
The AMA publishes and updates CPT codes annually to reflect changes in medical procedures
and technology.
, Question 8
Which modifier indicates that a separately identifiable Evaluation and Management (E/M)
service was performed on the same day as another procedure?
A. Modifier 22
B. Modifier 25
C. Modifier 59
D. Modifier 76
Correct Answer: B. Modifier 25
Solution:
Modifier 25 informs the payer that the provider performed a significant, separately identifiable
E/M service in addition to another procedure on the same date.
Question 9
A clean claim is one that:
A. Requires additional documentation
B. Contains complete and accurate information for processing
C. Is submitted on paper only
D. Has already been paid
Correct Answer: B. Contains complete and accurate information for processing
Solution:
A clean claim includes all required patient, provider, diagnosis, and procedure information,
allowing the insurance company to process it without requesting corrections.
Question 10
Which insurance plan generally requires members to select a primary care provider (PCP)?
A. PPO
B. HMO
C. Indemnity Plan
D. POS without PCP
Correct Answer: B. HMO
Solution:
Health Maintenance Organizations (HMOs) typically require members to:
