AMCA BILLING & CODING 2026 EXAMS TEST QUESTIONS
AND SOLUTIONS RATED A+
✔✔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 - ✔✔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 - ✔✔D
✔✔Physicians usually submit claims for patients and receive payments directly for the
payers. The policy holder authorizes this by signing and dating a:
a. Accept assignment
b. Schedule of benefits
c. Assignment of benefits
d. Encounter form - ✔✔C
✔✔Under the HIPAA Privacy Rule, providers do not need specific authorization in order
to release a patients PHI for TPO purposes. What does TPO stand for?
a. Treatment, patient protection, operations
b. Treatment, payment and health care operations
c. Type of payment, patient and observation
d. Type of insurance, payment, and health care operations - ✔✔B
✔✔If both parents cover dependents on their plan, the child's primary insurance is
usually determined by the birthday rule. What is meant by the birthday rule?
a. If the mother is older than the father than she is primary
b. The parent whose birthday is earlier in the calendar year is the primary
c. The father is usually older than the mother so he is the primary
d. The parent whose birthday is closest to the child's birthday is the primary - ✔✔B
✔✔There are three participants in the medical insurance relationship: the first party, the
second party and the third party. Who is referred to as the second party?
a. Physician
b. Secondary insurance
c. Patient
d. Insurance company - ✔✔C
✔✔Co-insurance is calculated based on:
, Select One:
a. A capitation rate
b. The numbers of policy holders in a plan
c. A fixed charge for each visit
d. A percentage of a charge - ✔✔D
✔✔If a health plan member receives medical services from a provider who does not
participate in the plan, the cost for the member is typically:
a. Lower
b. Negotiable
c. Higher
d. The Same - ✔✔C
✔✔The tertiary insurance pays:
a. After the first and second payer
b. After the receipt of the claim
c. After the patient has paid the co-insurance
d. After the payer - ✔✔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 - ✔✔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 - ✔✔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 - ✔✔C
✔✔Multigravida is a term associated with:
a. Arthritis
b. Glaucoma
c. Bronchitis
d. Pregnancy - ✔✔D
AND SOLUTIONS RATED A+
✔✔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 - ✔✔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 - ✔✔D
✔✔Physicians usually submit claims for patients and receive payments directly for the
payers. The policy holder authorizes this by signing and dating a:
a. Accept assignment
b. Schedule of benefits
c. Assignment of benefits
d. Encounter form - ✔✔C
✔✔Under the HIPAA Privacy Rule, providers do not need specific authorization in order
to release a patients PHI for TPO purposes. What does TPO stand for?
a. Treatment, patient protection, operations
b. Treatment, payment and health care operations
c. Type of payment, patient and observation
d. Type of insurance, payment, and health care operations - ✔✔B
✔✔If both parents cover dependents on their plan, the child's primary insurance is
usually determined by the birthday rule. What is meant by the birthday rule?
a. If the mother is older than the father than she is primary
b. The parent whose birthday is earlier in the calendar year is the primary
c. The father is usually older than the mother so he is the primary
d. The parent whose birthday is closest to the child's birthday is the primary - ✔✔B
✔✔There are three participants in the medical insurance relationship: the first party, the
second party and the third party. Who is referred to as the second party?
a. Physician
b. Secondary insurance
c. Patient
d. Insurance company - ✔✔C
✔✔Co-insurance is calculated based on:
, Select One:
a. A capitation rate
b. The numbers of policy holders in a plan
c. A fixed charge for each visit
d. A percentage of a charge - ✔✔D
✔✔If a health plan member receives medical services from a provider who does not
participate in the plan, the cost for the member is typically:
a. Lower
b. Negotiable
c. Higher
d. The Same - ✔✔C
✔✔The tertiary insurance pays:
a. After the first and second payer
b. After the receipt of the claim
c. After the patient has paid the co-insurance
d. After the payer - ✔✔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 - ✔✔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 - ✔✔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 - ✔✔C
✔✔Multigravida is a term associated with:
a. Arthritis
b. Glaucoma
c. Bronchitis
d. Pregnancy - ✔✔D
