CBCS Exam Study Guide Questions
2025. (Correct Answers)
Medical Billing & Coding as a Career - correct answer *Claims assistant professional or claims manager,
q q q q q q q q q q q q q q q q
*Coding Specialist, * Collection Manager, *Electronic Claims Processor, *Insurance Billing Specialist, *
q q q q q q q q q q q q
Insurance Coordinator, *Insurance Counselor, *Medical Biller, *Medical & Financial Records Manager, *
q q q q q q q q q q q q
Billing & Coding Specialist
q q q
What are Medical Ethics? - correct answer Standards of conduct based on moral principle. They are generally
q q q q q q q q q q q q q q q q q
accepted as a guide for behavior towards pt's, dr's, co-workers, the gov, and ins co's.
q q q q q q q q q q q q q q
What does acting within ethical behavior boundaries mean? - correct answer carrying out one's
q q q q q q q q q q q q q q
responsibilities w/ integrity, dignity, respect, honesty, competence, fairness, & trust.
q q q q q q q q q
Legal Aspects of of Medical Billing & Coding: - correct answer ...
q q q q q q q q q q q
Compliance regulations: - correct answer Most billing-related cases are based on HIPPA and False Claims Act
q q q q q q q q q q q q q q q
Health Insurance Portability & Accountability Act (HIPPA) - correct answer Enacted in 1996, created by the
q q q q q q q q q q q q q q q q
Health Care Fraud & Abuse Control Program-enacted to check for fraud and abuse in the Medicare/Medicaid
q q q q q q q q q q q q q q q q
Programs and private payers q q q
What are the 2 provisions of HIPPA? - correct answer Title I: Insurance Reform
q q q q q q q q q q q q q
,Title II: Administrative Simplification
q q q
What is Title I of HIPPA? - correct answer Insurance Reform-primary purpose is to provide continuous ins
q q q q q q q q q q q q q q q q q
coverage for worker & their dependents when they change or lose jobs. Also *Limits the use of preexisting
q q q q q q q q q q q q q q q q q q
conditions exclusions *Prohibits discrimination from past or present poor health *Guarantees certain
q q q q q q q q q q q q
employees/indv the right to purchase new health ins coverage after losing job *Allows renewal of health ins q q q q q q q q q q q q q q q q q
cov regardless of an indv's health cond. that is covered under the particular policy.
q q q q q q q q q q q q q
What is Title II of HIPPA? - correct answer Administrative Simplification-goal is to focus on the health care
q q q q q q q q q q q q q q q q q q
practice setting to reduce administrative cost & burdens. Has 2 parts- 1) development and implementation of
q q q q q q q q q q q q q q q q
standardized health-related financial & administrative activities electronically 2) Implementation of privacy
q q q q q q q q q q q
& security procedures to prevent the misuse of health info by ensuring confidentiality
q q q q q q q q q q q q
What is the False Claims Act (FCA)? - correct answer Federal law that prohibits submitting a fraudulent claim
q q q q q q q q q q q q q q q q q q
or making a false statement or representation in connection w/ a claim. Also protects & rewards whistle-
q q q q q q q q q q q q q q q q
blowers.
What is the National Correct Coding Initiative (NCCI)? - correct answer Developed by CMS to promote the
q q q q q q q q q q q q q q q q q
national correct coding methodologies & to control improper coding that lead to inappropriate payment of
q q q q q q q q q q q q q q q
Part B health ins claims.
q q q q
How many edits does NCCI include? - correct answer 2: 1)Column 1/Column 2 (prev called
q q q q q q q q q q q q q q q
Comprehensive/Component) Edits q
2) Mutually Exclusive Edits
q q q
Column 1/Column 2 edits (NCCI) - correct answer Identifies code pairs that should not be billed together b/c 1
q q q q q q q q q q q q q q q q q q q
code (Column 1) includes all the services described by another code (Column 2)
q q q q q q q q q q q q
Mutually Exclusive Edits (NCCI) - correct answer ID's code pairs that, for clinical reasons, are unlikely to be
q q q q q q q q q q q q q q q q q q
performed on the same pt on the same day q q q q q q q q
What are the possible consequences of inaccurate coding and incorrect billing? - correct answer *delayed
q q q q q q q q q q q q q q q
processing & payment of claims *reduced payments, denied claims *fine and/or imprisonment *exclusion
q q q q q q q q q q q q q
from payer's programs, loss of dr's license to practice med
q q q q q q q q q
,Who has the task of investigate and prosecuting health care fraud & abuse? - correct answer The Office of
q q q q q q q q q q q q q q q q q q q
Inspector General (OIG) q q
Fraud - correct answer knowingly & intentionally deceiving or misrepresenting info that may result in
q q q q q q q q q q q q q q q
unauthorized benefits. It is a felony and can result in fines and/or prison. q q q q q q q q q q q q
Who audits claims? - correct answer State & federal agencies as well as private ins co's
q q q q q q q q q q q q q q q
What are common forms of fraud? - correct answer billing for services not furnished, unbundling, &
q q q q q q q q q q q q q q q q
misrepresenting diagnosis to justify payment q q q q
Abuse - correct answer incidences or practices, not usually considered fraudulent, that are inconsistent w/
q q q q q q q q q q q q q q q
the accepted medical business or fiscal practices in the industry.
q q q q q q q q q
What are examples of Abuse? - correct answer submitting a claim for services/procedures performed that is
q q q q q q q q q q q q q q q q
not medically necessary, and excessive charges for services, equipment or supplies.
q q q q q q q q q q
What is a method use to minimize danger, hazards, & liabilities associated w/ abuse? - correct answer Risk
q q q q q q q q q q q q q q q q q q
Management
Patient Confidentiality - correct answer All pt's have right to privacy & all info should remain privileged. Only
q q q q q q q q q q q q q q q q q q
discuss pt info when necessary to do job. Obtain a signed consent form to release medical info to ins co or
q q q q q q q q q q q q q q q q q q q q q
other individual. q
When may providers use PHI (Protected Health Information) w/o specific authorization under the HIPPA
q q q q q q q q q q q q q q
Privacy Rule? - correct answer When using for TPO, Treatment (primarily for the purpose of discussion of pt's
q q q q q q q q q q q q q q q q q q
case w/ other dr's) Payment (providers submit claims on behalf of pt's) & Operations (for purposes such as
q q q q q q q q q q q q q q q q q q
training staff & quality improvement) q q q q
What is Employer Liability? - correct answer Means physicians are legally responsible for their own conduct
q q q q q q q q q q q q q q q q
and any actions of their employees (designee) performed w/in the context of their employment. Referred to
q q q q q q q q q q q q q q q q
as "vicarious liability. A.K.A "respondent superior"-"let the master answer". Means employee can be sued &
q q q q q q q q q q q q q q q
brought to trial q q
, What is Employee Liability? - correct answer "Errors & Omissions Insurance"-protection against loss of
q q q q q q q q q q q q q q
monies caused by failure through error or unintentional omission on the part of the indv or service submitting
q q q q q q q q q q q q q q q q q q
the claim. ****Some dr's contract w/ a billing service (clearinghouse) to handle claims submission, & some
q q q q q q q q q q q q q q q q
agreements contain a clause stating that the dr will hold the co harmless from "liability resulting from claims
q q q q q q q q q q q q q q q q q q
submitted by the service for any account", means dr is responsible for mistakes made by billing service, errors
q q q q q q q q q q q q q q q q q q
& omissions is not needed in the instance. ******However, if dr ever asks the ins biller to do the least bit
q q q q q q q q q q q q q q q q q q q q q
questionable, such as write of pt's balances for certain pt's automatically, make sure you have a legal
q q q q q q q q q q q q q q q q q
document or signed waiver of liability relieving you of responsibility for such actions.
q q q q q q q q q q q q
What is a Medical Record & what is it comprised of? - correct answer documentation of the pt's social &
q q q q q q q q q q q q q q q q q q q q
medical history, family history, physical exam findings, progress notes, radiology & lab results, consultation
q q q q q q q q q q q q q q
reports and correspondence to pt- Is the foremost tool of clinical care and communication.
q q q q q q q q q q q q q
What is a medical report? - correct answer part of the medical record & is a permanent legal document that
q q q q q q q q q q q q q q q q q q q q
formally states the consequences of the pt's exam or treatment in letter or report form. IT IS THIS RECORD
q q q q q q q q q q q q q q q q q q q
THAT PROVIDES INFO NEEDED TO COMPLETE THE INS CLAIM FORM.
q q q q q q q q q
Reasons for Documentation - correct answer Important that every pt seen by dr has comprehensive legible
q q q q q q q q q q q q q q q q
documentation about pt's illness, treatment, & plans for following reasons: q q q q q q q q q
*Avoidance of denied or delayed payment by ins co investigating the medical necessity of services
q q q q q q q q q q q q q q
*Enforcement of medical record-keeping rules by ins co requiring accurate documentation that supports q q q q q q q q q q q q q
procedure & diagnosis codes. q q q
*Subpoena of medical records by state investigators or the court for review
q q q q q q q q q q q
*Defense of professional liability claim q q q q
Retention Of Medical Records - correct answer Is governed by state & local laws & may vary from state-to-
q q q q q q q q q q q q q q q q q q
state. Most dr are required to retain records indefinitely, deceased pt records should be kept for @ least 5
q q q q q q q q q q q q q q q q q q q
years
Med Term - correct answer ...
q q q q q
Diagnosis suffixes: - correct answer ... q q q q q
2025. (Correct Answers)
Medical Billing & Coding as a Career - correct answer *Claims assistant professional or claims manager,
q q q q q q q q q q q q q q q q
*Coding Specialist, * Collection Manager, *Electronic Claims Processor, *Insurance Billing Specialist, *
q q q q q q q q q q q q
Insurance Coordinator, *Insurance Counselor, *Medical Biller, *Medical & Financial Records Manager, *
q q q q q q q q q q q q
Billing & Coding Specialist
q q q
What are Medical Ethics? - correct answer Standards of conduct based on moral principle. They are generally
q q q q q q q q q q q q q q q q q
accepted as a guide for behavior towards pt's, dr's, co-workers, the gov, and ins co's.
q q q q q q q q q q q q q q
What does acting within ethical behavior boundaries mean? - correct answer carrying out one's
q q q q q q q q q q q q q q
responsibilities w/ integrity, dignity, respect, honesty, competence, fairness, & trust.
q q q q q q q q q
Legal Aspects of of Medical Billing & Coding: - correct answer ...
q q q q q q q q q q q
Compliance regulations: - correct answer Most billing-related cases are based on HIPPA and False Claims Act
q q q q q q q q q q q q q q q
Health Insurance Portability & Accountability Act (HIPPA) - correct answer Enacted in 1996, created by the
q q q q q q q q q q q q q q q q
Health Care Fraud & Abuse Control Program-enacted to check for fraud and abuse in the Medicare/Medicaid
q q q q q q q q q q q q q q q q
Programs and private payers q q q
What are the 2 provisions of HIPPA? - correct answer Title I: Insurance Reform
q q q q q q q q q q q q q
,Title II: Administrative Simplification
q q q
What is Title I of HIPPA? - correct answer Insurance Reform-primary purpose is to provide continuous ins
q q q q q q q q q q q q q q q q q
coverage for worker & their dependents when they change or lose jobs. Also *Limits the use of preexisting
q q q q q q q q q q q q q q q q q q
conditions exclusions *Prohibits discrimination from past or present poor health *Guarantees certain
q q q q q q q q q q q q
employees/indv the right to purchase new health ins coverage after losing job *Allows renewal of health ins q q q q q q q q q q q q q q q q q
cov regardless of an indv's health cond. that is covered under the particular policy.
q q q q q q q q q q q q q
What is Title II of HIPPA? - correct answer Administrative Simplification-goal is to focus on the health care
q q q q q q q q q q q q q q q q q q
practice setting to reduce administrative cost & burdens. Has 2 parts- 1) development and implementation of
q q q q q q q q q q q q q q q q
standardized health-related financial & administrative activities electronically 2) Implementation of privacy
q q q q q q q q q q q
& security procedures to prevent the misuse of health info by ensuring confidentiality
q q q q q q q q q q q q
What is the False Claims Act (FCA)? - correct answer Federal law that prohibits submitting a fraudulent claim
q q q q q q q q q q q q q q q q q q
or making a false statement or representation in connection w/ a claim. Also protects & rewards whistle-
q q q q q q q q q q q q q q q q
blowers.
What is the National Correct Coding Initiative (NCCI)? - correct answer Developed by CMS to promote the
q q q q q q q q q q q q q q q q q
national correct coding methodologies & to control improper coding that lead to inappropriate payment of
q q q q q q q q q q q q q q q
Part B health ins claims.
q q q q
How many edits does NCCI include? - correct answer 2: 1)Column 1/Column 2 (prev called
q q q q q q q q q q q q q q q
Comprehensive/Component) Edits q
2) Mutually Exclusive Edits
q q q
Column 1/Column 2 edits (NCCI) - correct answer Identifies code pairs that should not be billed together b/c 1
q q q q q q q q q q q q q q q q q q q
code (Column 1) includes all the services described by another code (Column 2)
q q q q q q q q q q q q
Mutually Exclusive Edits (NCCI) - correct answer ID's code pairs that, for clinical reasons, are unlikely to be
q q q q q q q q q q q q q q q q q q
performed on the same pt on the same day q q q q q q q q
What are the possible consequences of inaccurate coding and incorrect billing? - correct answer *delayed
q q q q q q q q q q q q q q q
processing & payment of claims *reduced payments, denied claims *fine and/or imprisonment *exclusion
q q q q q q q q q q q q q
from payer's programs, loss of dr's license to practice med
q q q q q q q q q
,Who has the task of investigate and prosecuting health care fraud & abuse? - correct answer The Office of
q q q q q q q q q q q q q q q q q q q
Inspector General (OIG) q q
Fraud - correct answer knowingly & intentionally deceiving or misrepresenting info that may result in
q q q q q q q q q q q q q q q
unauthorized benefits. It is a felony and can result in fines and/or prison. q q q q q q q q q q q q
Who audits claims? - correct answer State & federal agencies as well as private ins co's
q q q q q q q q q q q q q q q
What are common forms of fraud? - correct answer billing for services not furnished, unbundling, &
q q q q q q q q q q q q q q q q
misrepresenting diagnosis to justify payment q q q q
Abuse - correct answer incidences or practices, not usually considered fraudulent, that are inconsistent w/
q q q q q q q q q q q q q q q
the accepted medical business or fiscal practices in the industry.
q q q q q q q q q
What are examples of Abuse? - correct answer submitting a claim for services/procedures performed that is
q q q q q q q q q q q q q q q q
not medically necessary, and excessive charges for services, equipment or supplies.
q q q q q q q q q q
What is a method use to minimize danger, hazards, & liabilities associated w/ abuse? - correct answer Risk
q q q q q q q q q q q q q q q q q q
Management
Patient Confidentiality - correct answer All pt's have right to privacy & all info should remain privileged. Only
q q q q q q q q q q q q q q q q q q
discuss pt info when necessary to do job. Obtain a signed consent form to release medical info to ins co or
q q q q q q q q q q q q q q q q q q q q q
other individual. q
When may providers use PHI (Protected Health Information) w/o specific authorization under the HIPPA
q q q q q q q q q q q q q q
Privacy Rule? - correct answer When using for TPO, Treatment (primarily for the purpose of discussion of pt's
q q q q q q q q q q q q q q q q q q
case w/ other dr's) Payment (providers submit claims on behalf of pt's) & Operations (for purposes such as
q q q q q q q q q q q q q q q q q q
training staff & quality improvement) q q q q
What is Employer Liability? - correct answer Means physicians are legally responsible for their own conduct
q q q q q q q q q q q q q q q q
and any actions of their employees (designee) performed w/in the context of their employment. Referred to
q q q q q q q q q q q q q q q q
as "vicarious liability. A.K.A "respondent superior"-"let the master answer". Means employee can be sued &
q q q q q q q q q q q q q q q
brought to trial q q
, What is Employee Liability? - correct answer "Errors & Omissions Insurance"-protection against loss of
q q q q q q q q q q q q q q
monies caused by failure through error or unintentional omission on the part of the indv or service submitting
q q q q q q q q q q q q q q q q q q
the claim. ****Some dr's contract w/ a billing service (clearinghouse) to handle claims submission, & some
q q q q q q q q q q q q q q q q
agreements contain a clause stating that the dr will hold the co harmless from "liability resulting from claims
q q q q q q q q q q q q q q q q q q
submitted by the service for any account", means dr is responsible for mistakes made by billing service, errors
q q q q q q q q q q q q q q q q q q
& omissions is not needed in the instance. ******However, if dr ever asks the ins biller to do the least bit
q q q q q q q q q q q q q q q q q q q q q
questionable, such as write of pt's balances for certain pt's automatically, make sure you have a legal
q q q q q q q q q q q q q q q q q
document or signed waiver of liability relieving you of responsibility for such actions.
q q q q q q q q q q q q
What is a Medical Record & what is it comprised of? - correct answer documentation of the pt's social &
q q q q q q q q q q q q q q q q q q q q
medical history, family history, physical exam findings, progress notes, radiology & lab results, consultation
q q q q q q q q q q q q q q
reports and correspondence to pt- Is the foremost tool of clinical care and communication.
q q q q q q q q q q q q q
What is a medical report? - correct answer part of the medical record & is a permanent legal document that
q q q q q q q q q q q q q q q q q q q q
formally states the consequences of the pt's exam or treatment in letter or report form. IT IS THIS RECORD
q q q q q q q q q q q q q q q q q q q
THAT PROVIDES INFO NEEDED TO COMPLETE THE INS CLAIM FORM.
q q q q q q q q q
Reasons for Documentation - correct answer Important that every pt seen by dr has comprehensive legible
q q q q q q q q q q q q q q q q
documentation about pt's illness, treatment, & plans for following reasons: q q q q q q q q q
*Avoidance of denied or delayed payment by ins co investigating the medical necessity of services
q q q q q q q q q q q q q q
*Enforcement of medical record-keeping rules by ins co requiring accurate documentation that supports q q q q q q q q q q q q q
procedure & diagnosis codes. q q q
*Subpoena of medical records by state investigators or the court for review
q q q q q q q q q q q
*Defense of professional liability claim q q q q
Retention Of Medical Records - correct answer Is governed by state & local laws & may vary from state-to-
q q q q q q q q q q q q q q q q q q
state. Most dr are required to retain records indefinitely, deceased pt records should be kept for @ least 5
q q q q q q q q q q q q q q q q q q q
years
Med Term - correct answer ...
q q q q q
Diagnosis suffixes: - correct answer ... q q q q q
