AMCA Medical Coder & Biller Certification (MCBC) Practice Exam

These questions are part of the practice quiz. Start practicing

• Which step involves collecting payments and managing accounts receivable?
• Which ICD chapter includes codes for gastric malignancy?
• What is assessed in Step 10 of the revenue cycle?
• What is considered a component of HIPAA's privacy regulations?
• In the context of medical billing, what does certification number usually refer to?
• What is the process of examining claims and determining benefits by a health plan called?
• Which code set is most commonly used by Medicaid?
• What term is commonly used to refer to Medicaid beneficiaries?
• What is the process used by payers to review claims before they are processed known as?
• What does the prompt pay law aim to ensure?
• Which form must providers complete to renew participation in Medicare?
• What is the term for linking a diagnosis to the services billed for a patient's treatment?
• Which of the following denotes a surgical removal of tissue in medical terminology?
• In the context of coding, what does the term "revision" refer to?
• What action must a coder take to represent multiple diagnoses?
• What determines whether Medicare will cover the cost of a service?
• Which HIPAA title includes guidelines on managed care organizations?
• Which of the following is NOT a benefit of using electronic medical records (EMRs)?
• Which organization is a not-for-profit private health insurance provider with membership ID numbers starting with three letters?
• What is the process of examining claims and records for accuracy and completeness called?
• What do CPT codes primarily describe?
• What does the revenue cycle monitoring primarily ensure after claims submission?
• What describes a situation in which a patient cannot perform all job functions for a limited period?
• In medical billing, what do providers receive for covered medical services?
• What type of health plan combines a high deductible with a savings account to managed out-of-pocket costs?
• Which of the following best describes a preauthorization?
• What does the medical term "trachea" refer to?
• What term describes a patient's history with illnesses, injuries, and treatments?
• What does the suffix -ectomy refer to in medical terminology?
• What is the medical term for rupture?
• What does sequencing refer to in the context of medical coding?
• What billing method is used for outpatient services provided by a non-physician practitioner?
• In coding, what does the term "unlisted code" refer to?
• Which action is defined as managing follow-ups on patient accounts?
• What type of insurance provides wage replacement and medical benefits for employees injured at work?
• Which of the following best characterizes the nature of Medicaid?
• What is a key factor in determining clean claims?
• What does enrollment in PECOS generally indicate?
• What organization is responsible for maintaining the permanent national codes in CMS HCPCS?
• Which coding convention indicates that more than one code is required to document a patient's condition?
• What is a federal program administered by state governments that provides medical assistance for low-income individuals?
• Which HIPAA title addresses tax-related health provisions?
• Which entity developed HCPCS codes?
• Which MCO plan typically requires referrals to see specialists?
• Which law protects a patient's private health information?
• What term describes the processes involved in managing patient accounts and follow-up actions?
• What is the National Provider Identifier (NPI)?
• What is the ninth step in the revenue cycle related to patient billing?
• What are payments for covered services made to providers by health plans called?
• What type of fracture occurs as a result of a disease?
• Which audit type focuses on past claims after remittance advice has been received?
• What term describes the legal responsibility of an employer for their employee's actions?
• Which HIPAA title addresses revenue offsets?
• In which step of the revenue cycle do providers submit claims to insurance companies?
• What do parentheses represent in the ICD-10-CM manual?
• Which system controls CPT code pairs that can be reported on the same day?
• What does the suffix -rrhea indicate?
• What is the first step in the revenue cycle process?
• Which program provides disability benefits for federal employees?
• What kind of codes does the ICD-10-CM system primarily focus on?
• Which benefit structure was first introduced by health maintenance organizations?
• What is the term for the progression of a patient's illness from the initial symptom to the current status?
• What does the CPT code set include?
• Which step in the revenue cycle ensures that patients' records are collected and managed accurately before the visit?
• What do codes beginning with 'H' in HCPCS represent?
• Minor surgical procedures are generally associated with which global period?
• In the tabular list of ICD-10-CM, what are the major topic headings known as?
• What is the primary purpose of the HCPCS coding system?
• What is the purpose of coding morbidity data?
• What term is used for a practice's revenue?
• Which program primarily assists low-income individuals in obtaining medical services?
• Which aspect of billing can result in penalties if not followed correctly?
• Temporary disability benefits are often based on what factor?
• What model is commonly used by payers in the healthcare industry?
• Which of the following services is covered by Medicare Part A?
• In medical billing, what does the abbreviation "CMS" stand for?
• What is the abbreviation for diagnosis on the encounter form or superbill?
• What key activity occurs during Step 8 of the revenue cycle?
• Medicare Part B is also known as what type of insurance?
• Which data set is foundational for sequencing diagnoses and reporting procedures in inpatient coding?
• What supporting documents are essential when assigning an unlisted CPT code?
• What form is current for submitting paper claims approved by the NUCC?
• What is the significance of Category II codes in medical coding?
• What is the role of the primary care physician in a HMO system?
• Who coordinates patient care under HMO plans and is also known as a gatekeeper?
• What is the medical term for a headache?
• Which step verifies the accuracy of the coding in the Tabular List?
• Who is referred to as the physician of record?
• Which codes from the HCPCS manual are used when there is no specific code that describes the service or supply?
• Which HIPAA title aims to prevent healthcare fraud and abuse?
• How frequently may some states issue Medicaid cards to their subscribers?
• What must be done to ensure accurate CPT code assignment?
• What is the first character of an ICD-10-CM code?
• Electronic health records (EHR) are designed to be accessible by?
• Which step in the revenue cycle involves ensuring there are no errors in the submitted codes?
• What is required for Medicaid claim submission?
• What is the role of modifiers in the CPT coding system?
• What is another name for a prior authorization number?
• How are the categories listed in the tabular list organized?
• What is typically included in a patient statement?
• What are the two types of coverage determinations Medicare uses?
• What primary function does balance billing serve?
• What is a characteristic of POS plans in managed care?
• What is a copayment?
• What is the primary focus of HIPAA Title IV?
• What is defined as the condition primarily responsible for a patient's hospital admission?
• What action is taken to alter a final determination regarding payment discrepancies?
• What is required for services that are rarely provided in the context of medical billing?
• What step follows checking in patients in the revenue cycle process?
• Which plan is primarily designed for active duty military personnel?
• What is the limiting charge in reference to non-participating healthcare professionals?
• In outpatient diagnosis coding, what is the main term used for?
• What is the payer's responsibility regarding the review of medical claims?
• What type of insurance is Medicare Part B?
• What is the primary function of the ICD-10-CM?
• What services does Medicare Part A cover?
• What laws require timely payments for clean claims and impose penalties for violations?
• Which of the following is NOT considered part of medical provider expenses?
• In the context of billing, what does the term 'write off' refer to?
• What are prior authorization numbers primarily used for?
• The PECOS system is primarily used for which purpose?
• Which term describes measures taken to ensure the accuracy of medical records?
• Which of the following is not a component of the medical history?
• Who completes the CMS-460 form?
• Which of the following relates to the financial responsibility of the patient before their insurance benefits apply?
• What does HCPCS stand for?
• What is an objective indication that can be evaluated by a physician?
• What is the primary purpose of the HCPCS coding system?
• Which report summarizes all patient charges and payments collected for a specific date?
• What is the main purpose of modifier codes in billing?
• Which step is involved in the process of verifying the financial obligations of the patient?
• What type of health care MCO plan typically does not pay for out-of-network services or providers?
• What does the acronym PPO stand for in healthcare?
• How long is the global period for major surgical procedures?
• What organization is tasked with protecting workers from health and safety risks?
• What character length can ICD-10-CM codes consist of?
• Which code is used when a patient is treated for sequela from an injury?
• During which step of the revenue cycle are patients checked out after their services?
• What is the fourth step in outpatient diagnosis coding?
• What does NCCI stand for in coding and billing?
• Which type of audit is conducted after receiving remittance advice?
• What is the amount the insured must pay before benefits begin called?
• What is the term for a meeting between a patient and a medical professional?
• What is the primary focus of a collection agency in a healthcare setting?
• HIPAA is primarily intended to protect what aspect of healthcare?
• Which type of healthcare record captures a patient's interactions with multiple physicians?
• What important information should be collected from a new patient?
• What does HIPAA Title I cover?
• What is indicated by the presence of a "category II" code?
• What is the global period associated with a simple procedure?
• What is the term for the cost of services rendered that the patient must pay after meeting the deductible?
• Which plan typically has higher out-of-pocket costs but offers more provider options?
• What type of service does a copayment typically pertain to?
• What is the second step in the six steps to assigning CPT codes?
• What are private electronic files managed by patients called?
• What does an electronic medical record (EMR) represent?
• What does a cholecystectomy involve?
• What is the first step in outpatient diagnosis coding?
• What is the medical term for a blood clot in an artery of the brain?
• What does E/M coding primarily assess?
• Managed care organizations primarily aim to do what regarding healthcare?
• What does an ICD-10-CM code typically consist of?
• What is Medicare Part D primarily designed to provide?
• What is the primary purpose of health maintenance organizations (HMOs)?
• What should a coder consider when assigning a code for a patient with a pre-existing condition?
• What must be checked after listing codes to ensure they are correct in outpatient diagnosis coding?
• Which Medicaid category requires patients to see a specific physician or use a specific pharmacy?
• Which PPO plan is available for active duty servicemembers?
• What does family history review generally assess?
• What type of medical insurance reimburses a policyholder for medical services based on its schedule of benefits?
• What are the primary payment structures used in a fee-for-service model?
• What step involves using the Alphabetic Index during the coding process?
• What does HIPAA stand for?
• How is the CPT radiology section organized?
• During which step are providers supposed to verify the accuracy of the codes used?
• Which program provides coverage to veterans and their dependents in certain situations?
• What does the modifier AA indicate in anesthesia coding?
• What is the term for outstanding amounts owed to a healthcare provider by patients and insurers?
• Which of the following is NOT a type of managed care organization plan?
• What is the second step in outpatient diagnosis coding?
• What term is used to describe groups of healthcare providers working together to coordinate care for Medicare enrollees?
• Which of the following is NOT a purpose of prior authorization?
• Which procedure is best suited for Category III codes?
• Which of the following is a commonly required component for certain medical billing services?
• Which of the following is NOT a characteristic of indemnity plans?
• What is the primary responsibility of an accountable care organization (ACO)?
• Which HIPAA title addresses group health plans?
• What payment method is based on provider charges?
• The E section of Level II coding pertains to what type of equipment?
• What is commonly abbreviated as E/M in medical coding?
• Which federal guidelines must be adhered to by collection agencies?
• What computerized system is used by Medicare to prevent overpayments to providers?
• Which type of health insurance policy is characterized by a contractual agreement aimed at reducing healthcare costs?
• What is the standard HMO plan automatically assigned to active duty servicemembers?
• How long has it been since a new patient received services from the provider?
• What is the process for checking a new patient's health requirements for a procedure called?
• What does PHR stand for in healthcare documentation?
• What is another term for a placeholder character in coding?
• A provider's coding accuracy is important for which reason?
• Which term describes a list organized based on statistical language?
• What is the alternate name for the HIPAA referral certification and authorization?
• Which term describes the system of managing patient care to ensure the necessity of services within HMO plans?
• What does the term "coinsurance" refer to in health insurance?
• Which method is specifically used to obtain authorization for a medical procedure?
• What is the term for the portion of prescription drug costs a Medicare patient must pay out of pocket?
• What is it called when a patient is charged the difference between the allowed amount and the charges billed?
• Who is eligible for CHAMPVA benefits?
• Which of the following describes a primary care physician's role in MCOs?
• Which CPT codes consider three factors, including history, examination, and medical decision making?
• What is the legal process called when a patient's debt is eliminated by a court?
• Which type of plan offers a greater degree of choice and flexibility for patients?
• What is the purpose of the CMS-460 form?
• What term describes a referral allowing a patient to consult a specialist?
• How do PPOs typically compensate participating providers?
• What is the purpose of place of service codes on the CMS 1500 claim form?
• What is the full title of the CPT manual?
• Which entity is compensated based on a percentage of payments received from patients?
• Which codes begin with a letter followed by four numeric digits?
• In an inpatient setting, what diagnosis is sequenced first?
• Which of the following best describes Category I codes?
• Where is a UB04 or HIPAA847I claim typically used?
• What is an 'unlisted code' in medical coding?
• What does RAC stand for in the context of auditing?
• What program partners with Medicare to provide health coverage for eligible TRICARE beneficiaries?
• What term is used for claims that are accepted for adjudication by payers?
• Which of the following is typically included in a patient’s social history?
• Which form is used to electronically submit insurance claims in healthcare?
• What document provides information about an accident in a workers' compensation case?
• What is referred to as a practice's operating expenses?
• How is the alphabetic index organized?
• What does an adjustment in a patient's account refer to?
• Major surgical procedures typically have what global period?
• In which health insurance model do providers share in cost savings with insurers?
• Which step directly follows the establishment of financial responsibility in the revenue cycle?
• Which organization oversees the compliance of healthcare providers with HIPAA regulations?
• Which term describes a fracture that occurs without trauma, usually linked to an underlying condition?
• What is the term for a map between two different sets of information in coding?
• What is the term for a set of regulations enhancing patient's privacy protections and rights to information?
• What term describes a series of steps that leads to payment for patients' medical services?
• What type of report details a patient's initial assessment following an injury?
• Which process includes obtaining an NPI and enrolling in PECOS?
• What is the first step in the six steps to assigning CPT codes?
• What is cystitis?
• What is one of the key outcomes of HIPAA implementation?
• What document details the services provided to a patient, including charges and what they owe?
• What does the term "compliance" refer to in a medical context?
• What action comes after reviewing complete medical documentation in outpatient diagnosis coding?
• What document reflects a patient's progress and treatment responses?
• Which term refers to a method of billing that allows services provided by support staff under a physician’s supervision?
• What is the method of organizing files based on sorting by first name initial and last name?
• Which block on the claim form is specifically used for entering diagnosis codes?
• What is the purpose of an encounter form in the revenue cycle?
• What term refers to Medicare computer programs that profile average billing patterns for Evaluation and Management (E/M) codes?
• What type of disability may allow a worker to be rehabilitated in a different line of work?
• Which of the following MCO plans allows members to see out-of-network providers with approval from their primary care physician (PCP)?
• What does the review of billing compliance typically evaluate?
• What does the term 'sequela' refer to in medical terminology?
• What is essential for a successful claims process?
• Which demographic is primarily covered by Medicare?
• What type of disability is defined as an irreversible condition left after an injury?
• How often are CCI updates issued?
• What does PECOS stand for?
• What does the acronym NOS stand for in ICD coding?
• What document is sent with payment detailing payments and adjustments made during adjudication?
• Which entity is directed to combat fraud and abuse in the healthcare industry under HIPAA?
• Which type of vendors must ensure their software products are kept current?
• What is a premium in the context of medical insurance?
• Which Medicare part is known as a Medicare managed care plan?
• What is the role of the Recovery Audit Contractor (RAC) in healthcare?