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AMCA BILLING & CODING TEST 2025 Questions
What type of insurance allows treatment virtually anywhere with a high deductible that policy holders are willing to pay? a. COBRA b. EPO c. PPO d. HMO - ANS-C Veterans with service related disabilities are eligible for case under which of the following programs: a. CHAMPUS b. Medicare c. CHAMPVA d. TRICARE - ANS-C _______________________ is usually sponsored and partially paid by an employer. a. TRICARE b. Private Insurance c. Group Health Insurance d. Worker's Aide - ANS-C ______________________ are used to report encounters for circumstances other than a disease or injury in the ICD- 10 - CM. a. A codes b. V codes c. Z codes d. E codes - ANS-D The abbreviation PMPM stands for: a. Per member per month b. Provider membership per management c. Provider management provider manual d. Pre menstrual after midnight - ANS-A Schedule of benefits means: a. Coordination of benefits b. HMO c. Medical service covered under the insured's policy d. Managed care organization - ANS-C Medicare is funded by: a. State Funds b. Federal Funds c. Employers d. The patient - ANS-B
Physicians establish a list of their usual fees for: a. The charges they have written off b. The procedures and services they frequently perform c. Workers' Compensation patients d. Their Medicare patients - ANS-B The insurance carrier is allowed to use nay method to determine the amount for a service, also known as the: a. Allowed amount b. Fee schedule c. Deductible d. Insurance premium - ANS-B Which of the following statements is true under the doctrine of respondeat superior? a. The billing and coding specialist is superior to other members of the medical staff b. The billing and coding specialist is responsible for any errors made by the medical staff c. The physician is responsible for any errors made by the medical staff d. The person who has been employed for the longest period of time is responsible for any errors made by the medical staff - ANS-C HIPAA, stands for which of the following? a. Health Insurance Portability and Accountability Act b. Health Insurance Privacy Assessment and Agreement c. Health Insurance Privacy and Agreements d. Health Insurance Practices and Agreements - ANS-A Information given by a patient to medical personnel that cannot be disclosed without consent constitutes: a. Judgment b. Duty of care c. Privileged communication d. Negligence - ANS-C Why is a superbill/encounter form an important document in the office? a. It is used when considering purchasing medical billing software b. It has information needed for vendors c. It ensures the correct spelling of the patient's name d. It ensures the correct patient data information and procedure codes - ANS-D Which of the following facilities does not use CMS-1500 forms? a. ASC (Ambulatory Surgery Center) b. Nursing Home c. Acute care d. Dialysis clinic - ANS-D
c. After the patient has paid the co-insurance d. After the payer - ANS-A A certification number for a procedure is the result of which transaction and process? a. Claims status b. Coordination of benefits c. Referral and authorization d. Health care payments and remittance advice - ANS-C Which of the following is one of the sections in the CPT Coding Manual? a. Encounters b. Vaccinations c. Pharmacy d. Pathology and Laboratory - ANS-D A late effect may be indicated in documentation by the use of the expression(s): a. Primary or secondary b. Missile, puncture, with foreign body c. Due to an old—due to a previous d. Malignant - ANS-C Multigravida is a term associated with: a. Arthritis b. Glaucoma c. Bronchitis d. Pregnancy - ANS-D What insurance company is the payer of last resort? a. Blue Cross and Blue Shield b. Workers Compensation c. Medicaid d. Group Insurance - ANS-C An unintentional, harmful reaction to the correct dosage of a drug is called: a. A manifestation b. A co-existing condition c. A late effect d. An adverse effect - ANS-D Which of the following CPT conventions indicates the code description is revised? a. Red dot b. Plus sign c. Blue triangle d. Lightning bolt - ANS-C What is meant by the term "Code to the Highest Level of Specificity"?
a. Using the most specific code possible b. Using the code the doctor annotates, even if the physician notes do not coincide c. Code using the four-digit subcategory code, even when a five-digit code is available. d. Code using inconclusive and rule out diagnoses - ANS-A A medical term that contains the root word meaning "uterus": a. Oophrectomy b. Colporrhaphy c. Hysterectomy d. Salpingectomy - ANS-C If the patient is treated for both an acute and chronic condition, each of which has a separate code, how should the codes be listed? a. Acute code, chronic code b. Chronic code, acute code c. V code, condition code d. Acute code, V code - ANS-A A new patient is one who has not received services from the physician or any other physician in that group for: a. 3 years b. 1 year c. 2 years d. 90 days - ANS-A The abbreviation for PFSH is: a. Present, family and social history b. Past, family and/or social history c. Patient, family and/or systems history d. Past, family and systems history - ANS-B The three key factors in selecting E/M codes are: a. Time, severity of presenting problem and history b. History, examination and time c. History, examination and medical decision making d. Past history, history of present illness and chief complaint - ANS-C When a panel code from the Pathology and Laboratory section is reported: a. 50% of the listed tests must have been performed b. 90% of the listed tests must have been performed c. All the listed tests must have been performed d. All of the listed tests must have been performed on the same day - ANS-C What is the Medicare Coverage Gap also know as the "donut hole"? a. The amount of out of pocket costs after a certain amount of money has been spent from Medicare on prescription drugs
What is a capitated payment? a. This is when a provider can only see specific patients with specific insurance b. This is when a physician can only charge a specific amount of money c. This is a regular payment received by the physician d. This when a physician has a contract with an insurance company to be paid whether he sees the patient or not - ANS-D The patient aging report is used to: a. Collect overdue accounts from patients b. Enter write-offs to a patient's account c. Enter payments into the patient billing system d. Track overdue claims from payers - ANS-D A deviated septum dur to a nasal fracture could be considered a: a. Allergic effect b. Early effect c. Adverse effect d. Late effect - ANS-D What is a correctly completed claim submitted within the policy time limit? a. Dirty b. Draft c. Clean d. Incomplete - ANS-C The day sheet produced by the practice management program shows: a. What each patient owes the practice as of that date b. What each payer owes the practice as of that date c. They payments and charges that occurred on that date d. The overdue accounts on that date - ANS-C The word used in medical terminology to mean "toward the midline of the body" is: a. Dorsal b. Medial c. Lateral d. Ventral - ANS-B To indicate that something lies nearer the surface, use the term: a. Distal b. Superficial c. Deep d. Proximal - ANS-B The definition of fraud would be: a. submitting a claim with incorrect patient information
b. Unintentionally making a coding error c. Providing poor quality care to the patient d. Intentionally upcoding in order to increase payment - ANS-D In order to find a code using the ICD- 10 - CM manual, the first step is to look up ____________ in the index? a. main term b. nonessential modifier c. manifestation d. sub term - ANS-A A lab report cannot be used for coding purposes because: a. they are not reviewed by a physician before inclusion in the record b. Pathologists are not physicians c. They are not part of the health record d. They are diagnostic tests - ANS-A Which one of the following instructional notes suggests that a second code may be required? a. Code also b. Includes c. See also d. See - ANS-A Which CPT modifier should the billing and coding specialist attach to a consultation code when the service performed is required by a third party-payer r governmental regulatory body? a. - 59 (Distinct Procedural Services) b. - 32 (Mandated Services) c. - 22 (Unusual Procedural Services) d. - 26 (Professional Component) - ANS-B What do the letters NOS (not otherwise specified) indicate? a. Equals unspecified b. Encloses synonyms, alternative words or explanatory phrases c. Indicated terns that are to be codes elsewhere d. Appears under a code to further define or explain the content - ANS-A What do the letters NEC (not elsewhere classified) indicate? a. Encloses synonyms, alternative words, or explanatory phrases b. Appears under a code to further define or explain the content c. Indicates the use of code assignment for "other" when a more specific code does not exist d. Indicates terms that are to be coded elsewhere - ANS-C
d. Malignancy that is located within the original site if development - ANS-C Which of the following terms refers to a cancerous neoplasm in its original location? a. Ca in situ b. Benign c. Malignant primary d. Malignant secondary - ANS-A In accordance to the Health Insurance Portability and Accountability Act (HIPAA), which of the following organizations considers health plans, health care providers and clearinghouses as covered entities? a. American Heart Association (AHA) b. American Medical Association (AMA) c. Centers for Medicare and Medicaid Services (CMS) d. Utilization Review Accreditation Commission (URAC) - ANS-C Which of the following forms notifies a patient, in writing, that they will be required to cover the costs for services provided if the payment is denied by Medicare and deemed medically unnecessary? a. Release of Information b. Advanced Beneficiary Notice (ABN) c. Assignment of Benefits d. Arbitration Agreement - ANS-B Which of the following pieces of information would you find on the encounter form? a. Chief Complaint b. Lab Results c. Patient demographics d. Radiology reports - ANS-A The common abbreviation for chest x-ray is: a. CXRAY b. CXT c. CRAY d. CXR - ANS-D When coding HCPCS codes, which of the following symbols would mean that the code is an add-on code? a. A triangle b. A plus sign c. A bull's eye d. A red dot - ANS-B Assigning the proper ICD- 10 - CM code means following the proper order of selecting the code. Which step below should be the very first thing a coder does? a. Verify codes in Tabular List
b. Identify all main terms included in clinical diagnostic statements c. Locate each main term in the Alphabetic Index d. Read any instructional terms in the Tabular List - ANS-C Bad debt is defined as: a. Patient refunds b. Collectible A/R c. Uncollectible A/R d. Payer refunds - ANS-C The principal diagnosis when coding ICD- 10 - CM codes refers to which of the following? a. The signs or symptoms b. An external cause code c. a "Z" code for a history or cancer d. The condition or diagnosis that brought the patient into the facility - ANS-D The suffix - scopy means: a. Insertion b. Incision c. Visualize d. Excision - ANS-C When working under a managed care plan, physicians agree to: a. Accept fees that are predetermined by the plan b. Set fees within certain ranges provided by the plan c. Charge fees that are based on local community averages d. Base fees on national trends - ANS-A Who should be billed for the treatment of an emancipated minor? a. The guardian b. The minor c. The parent who came to the office with the minor d. The parent who is financially responsible for the minor - ANS-B Which of the following statements best describes unbundling? a. Coding a different CPT code for each procedure performed b. Coding a procedure with multiple codes and modifiers c. Coding a procedure with multiple code when a single code should be used d. Coding all procedures and services with one single code - ANS-C A patient was suspected of having a myocardial infarction. After staying in the hospital as an outpatient in observation, the doctor found nothing wrong and sent the patient home. What code would you use in this scenario? a. I21.9 Acute myocardial infarction, unspecified b. I20.0 Unstable angina c. Z03.4 Observation for suspected myocardial infarction
d. Type of insurance - ANS-B The four types of examinations, in order of difficulty (from least difficult to most difficult) are problem focused expanded problem focused, detailed and: a. Comprehensive b. Reactive c. Serious d. Diagnostic - ANS-A Coding is the: a. Way healthcare facilities receive reimbursement b. Number that is entered to open lock box c. Transformation of verbal description into numbers d. Assignment of appropriate codes on medical claim forms - ANS-D A code that reports more than one diagnosis with one code is a ____________. a. Complex code b. Combination code c. Compound code d. Multiple code - ANS-C The process done before claims submission to examine claims for accuracy and completeness is to: a. Revise b. Correct c. Audit d. Reject - ANS-C Coding to the highest level of specificity means: a. The doctor must be specific as possible in his diagnosis b. Using a fourth, fifth, sixth, or seventh digit when required c. Coding all the conditions listed in the patient's chart d. Coding just the condition for which the patient is being seen - ANS-B Verification of insurance benefits is usually done by: a. Calling the patient's employer b. Requesting a letter of eligibility from the carrier c. Asking the patient the effective date d. Calling the insurance carrier - ANS-D Which Medicare Part do most patients have in order to cover vaccinations? a. Part D b. Part B c. Part C d. Part A - ANS-B
Block 1 of the CMS 1500 contains what information? a. Insured name b. Patient's name c. Type of insurance coverage d. Carrier address - ANS-C What box on the CMS 1500 is for Dx codes? a. Box 36 b. Box 15 c. Box 4 d. Box 21 - ANS-D Claims that have errors or omissions that must be corrected and resubmitted to receive reimbursement are called: a. Clean b. Draft c. Corrected claim d. Incomplete - ANS-D Vocational rehabilitation programs provide _________________ for individuals with job- related disabilities. a. Compensation for lost wages b. Payment for medical expenses c. Physical therapy d. Training in a different job - ANS-D Karen was diagnosed with a squamous cell carsinoma arising in the cervix. The first 5 digits of the code is M08070. What 6th digit would be used in this diagnosis? a. 0 Benign meoplams b. /1 Neoplasms of uncertain and unknown behavior c. /6 Malignant neoplams, stated or presumed to be secondary d. /3 Malignant neoplasms, stated or presumed to be primary - ANS-D
