MEDICAL BILLING CODING 2026/2027 TESTS PAPER
QUESTIONS AND ANSWERS RATED A+
✔✔Tier 4 - ✔✔Providers and facilities not on the formulary
✔✔Formulary - ✔✔a list of prescription drugs covered by a specific health care plan
✔✔Charge Description Master (CDM) - ✔✔Information about health care services that
patients have received and financial transactions that have taken place.
✔✔Medicare Summary Notice (MSN) - ✔✔Document that outlines the amounts billed by
the provider and what the patient must pay the provider.
✔✔Cost sharing - ✔✔The balance the policyholder must pay to the provider.
✔✔Medical Necessity - ✔✔The documented need for a particular medical intervention.
✔✔2 reasons a claim may be denied - ✔✔Invalid subscriber name was given or coding
error was made
✔✔V Codes - ✔✔Classify visits when circumstances, and conditions, such as the cause
of injury, poisoning, and other adverse events
✔✔E Codes - ✔✔classify external causes of environmental events, circumstances, or
conditions that caused injury, condition, or poisoning (i.e. how an accident happened, if
drug overdose was accidental or intentional)
✔✔CPT Category 1 Codes - ✔✔Primarily cover physicians services but are used for
hospital outpatient. Modifiers are used
✔✔CPT Category II Codes - ✔✔Designed to serve as supplemental tracking codes that
can be used for performance measurement. Modifiers are used
✔✔CPT Category III - ✔✔Temporary coding for new technology and services that have
not met the requirements needed
✔✔HCPS Level II - ✔✔National Codes, Uses modifiers
✔✔HCPS Level 3 Codes - ✔✔Temporary Codes
✔✔How many CPT code category sections are listed in the CPT manual? - ✔✔6
, ✔✔MS-DRG grouper - ✔✔Software that helps coders assign the appropriate Medicare
severity diagnosis-related group based on the level of services provided, severity of the
illness or injury, and other factors.
✔✔APC Grouper - ✔✔Determine the appropriate ambulatory payment classification for
outpatient encounter
✔✔NON PAR - ✔✔15% over fee schedule amount
✔✔Non medical Code - ✔✔Why a payment was not paid or adjusted
✔✔A bilateral procedure - ✔✔A billing and coding specialists should add modifier -50
when reporting which procedure
✔✔The physician agrees to accept payment under the terms of the payers program. -
✔✔Accepting assignment on the CMS-1500 claim form indicates which of the following.
✔✔The coinsurance, co payment and deductibles are all responsibilities of the patient -
✔✔Which of the following statements is true when determining patient financial
responsibility by reviewing the remittance advice.
✔✔Edema- is swelling caused by excess fluids - ✔✔Which of the following is the
appropriate diagnosis for a patient who has an abnormal accumulation of fluid in her
lower leg that has resulted in swelling
✔✔Health care clearinghouse - ✔✔HIPPA transaction standards apply to which of the
following entities
✔✔Block 23 - ✔✔A billing and coding specialists should enter the prior the authorization
number on the following blocks.
✔✔Claims submitted via a secure network - ✔✔Which of the following is an example of
electronic claim submission
✔✔Advance Beneficiary Notice (ABN) - ✔✔Advanced beneficiary notice, or ABN is a
form that is required for Medicare recipients.
✔✔Patients demographics - ✔✔On the CMS 1500 Form blocks 1-13 are
✔✔A patients signature authorizing the release of any medical information necessary to
process the claim. - ✔✔Block 12
✔✔Other insured policy or group number - ✔✔Block 9a contains
QUESTIONS AND ANSWERS RATED A+
✔✔Tier 4 - ✔✔Providers and facilities not on the formulary
✔✔Formulary - ✔✔a list of prescription drugs covered by a specific health care plan
✔✔Charge Description Master (CDM) - ✔✔Information about health care services that
patients have received and financial transactions that have taken place.
✔✔Medicare Summary Notice (MSN) - ✔✔Document that outlines the amounts billed by
the provider and what the patient must pay the provider.
✔✔Cost sharing - ✔✔The balance the policyholder must pay to the provider.
✔✔Medical Necessity - ✔✔The documented need for a particular medical intervention.
✔✔2 reasons a claim may be denied - ✔✔Invalid subscriber name was given or coding
error was made
✔✔V Codes - ✔✔Classify visits when circumstances, and conditions, such as the cause
of injury, poisoning, and other adverse events
✔✔E Codes - ✔✔classify external causes of environmental events, circumstances, or
conditions that caused injury, condition, or poisoning (i.e. how an accident happened, if
drug overdose was accidental or intentional)
✔✔CPT Category 1 Codes - ✔✔Primarily cover physicians services but are used for
hospital outpatient. Modifiers are used
✔✔CPT Category II Codes - ✔✔Designed to serve as supplemental tracking codes that
can be used for performance measurement. Modifiers are used
✔✔CPT Category III - ✔✔Temporary coding for new technology and services that have
not met the requirements needed
✔✔HCPS Level II - ✔✔National Codes, Uses modifiers
✔✔HCPS Level 3 Codes - ✔✔Temporary Codes
✔✔How many CPT code category sections are listed in the CPT manual? - ✔✔6
, ✔✔MS-DRG grouper - ✔✔Software that helps coders assign the appropriate Medicare
severity diagnosis-related group based on the level of services provided, severity of the
illness or injury, and other factors.
✔✔APC Grouper - ✔✔Determine the appropriate ambulatory payment classification for
outpatient encounter
✔✔NON PAR - ✔✔15% over fee schedule amount
✔✔Non medical Code - ✔✔Why a payment was not paid or adjusted
✔✔A bilateral procedure - ✔✔A billing and coding specialists should add modifier -50
when reporting which procedure
✔✔The physician agrees to accept payment under the terms of the payers program. -
✔✔Accepting assignment on the CMS-1500 claim form indicates which of the following.
✔✔The coinsurance, co payment and deductibles are all responsibilities of the patient -
✔✔Which of the following statements is true when determining patient financial
responsibility by reviewing the remittance advice.
✔✔Edema- is swelling caused by excess fluids - ✔✔Which of the following is the
appropriate diagnosis for a patient who has an abnormal accumulation of fluid in her
lower leg that has resulted in swelling
✔✔Health care clearinghouse - ✔✔HIPPA transaction standards apply to which of the
following entities
✔✔Block 23 - ✔✔A billing and coding specialists should enter the prior the authorization
number on the following blocks.
✔✔Claims submitted via a secure network - ✔✔Which of the following is an example of
electronic claim submission
✔✔Advance Beneficiary Notice (ABN) - ✔✔Advanced beneficiary notice, or ABN is a
form that is required for Medicare recipients.
✔✔Patients demographics - ✔✔On the CMS 1500 Form blocks 1-13 are
✔✔A patients signature authorizing the release of any medical information necessary to
process the claim. - ✔✔Block 12
✔✔Other insured policy or group number - ✔✔Block 9a contains
