Medical Billing and Coding Final Exam Questions and Answers | Latest Version | 2025/2026 | Correct & Verified

Medical Billing and Coding Final Exam Questions and Answers | Latest Version | 2025/2026 | Correct & Verified What is the role of the Office of Inspector General (OIG) in healthcare? To detect and prevent healthcare fraud, waste, and abuse. What is the purpose of a compliance plan in a medical office? To prevent and correct billing and coding errors that could lead to fraud. What is the difference between primary and secondary insurance? Primary insurance pays first, and secondary insurance covers remaining balances. What is a preauthorization? Approval from an insurance company before performing specific procedures. What is a charge capture? The process of recording all services and procedures performed for billing. 2 What is the function of an encounter form? To record patient visits, diagnoses, and services provided for billing. What is an allowable amount in insurance terms? The maximum amount an insurer will pay for a covered service. What happens if a provider is out-of-network? The patient may pay higher costs since the provider has no contract with the insurer. What does medical documentation support in the coding process? Accurate selection of diagnosis and procedure codes. What is the function of the National Correct Coding Initiative (NCCI)? To prevent improper coding and unbundling of procedures. What is a global period in medical billing? The time frame during which related post-procedure care is included in one payment. 3 What is the purpose of the CPT modifier -25? To indicate a significant, separately identifiable E/M service on the same day as another procedure. What is the purpose of CPT modifier -59? To identify distinct procedural services not normally reported together. What is medical claim adjudication? The process by which an insurance company reviews and decides payment on a claim. What is an advance beneficiary notice (ABN)? A notice informing Medicare patients that a service may not be covered and they may be responsible for payment. What is the purpose of CPT modifier -26? To indicate the professional component of a service such as interpretation or supervision. What is the main purpose of medical billing in healthcare? 4 To collect payment for services rendered by submitting accurate claims to insurance providers. What does medical coding translate healthcare diagnoses and procedures into? Standardized alphanumeric codes for billing and recordkeeping. What organization maintains the CPT code set? The American Medical Association (AMA). What does ICD-10-CM primarily describe? Patient diagnoses and medical conditions. What does ICD-10-PCS primarily describe? Inpatient hospital procedures and surgeries. What does HCPCS Level II include? Codes for supplies, durable medical equipment, and non-physician services.