Certified Billing & Coding Specialist Exam Review Questions and Answers Updated 2026

Certified Billing & Coding Specialist
Exam Review Questions and
Answers Updated 2026
WhatAareAMedicalAEthics?A-
AAnswer✓AStandardsAofAconductAbasedAonAmoralAprinciple.AtheyAareAgenerallyAacceptedA
asAaAguideAforAbehaviorAtowardsApt's,Adr's,Acoworkers,AtheAgov,AandAinsAco's


WhatAdoesAactingAwithinAethicalAbehaviorAboundariesAmean?A-
AAnswer✓ACarryingAoutAone'sAresponsibilitiesAwithAintegrity,Adignity,Arespect,Ahonesty,Aco
mpetence,Afairness,AandAtrust


ComplianceAregulationsA-AAnswer✓AMostAbilling-
relatedAcasesAareAbasedAonAHIPAAAandAFalseAClaimsAAct


HealthAInsuranceAPortabilityA&AAccountabilityAActA(HIPAA)A-
AAnswer✓AEnactedAinA1996,AcreatedAbyAtheAHealthACareAFraudA&AAbuseAControlAProgra
m-
AenactedAtoAcheckAforAfraudAandAabuseAinAtheAMedicare/AMedicaidAProgramsAandAprivateA
payers


WhatAareA2AprovisionsAofAHIPAA?A-AAnswer✓ATitleA1:AInsuranceAReform
TitleA2:AAdministrativeASimplification


WhatAisATitleA1AofAHIPAA?A-AAnswer✓AInsuranceAReform-
primaryApurposeAisAtoAprovideAcontinuousAcoverageAforAworkersA&AtheirAdependentsAwhenA
theyAchangeAorAloseAjobs.AAlsoALimitsAtheAuseAofApre-existingAconditionsAexclusionsA
ProhibitsAdiscriminationAfromApastAorApresentApoorAhealthA
GuaranteesAcertainAemployees/AindividualAtheArightAtoApurchaseAnewAhealthAinsuranceAcove
rageAafterAlosingAjob
AllowsArenewalAofAhealthAinsuranceAcoverageAregardlessAofAanAindividualsAhealthAcondition
AthatAisAcoveredAunderAtheAparticularApolicy


WhatAisATitleA2AofAHIPAA?A-AAnswer✓AAdministrativeASimplification-
AgoalAisAtoAfocusAonAtheAhealthAcareApracticeAsettingAtoAreduceAadministrativeAcostA&Aburd
ens.A

,HasA2Aparts
1)AdevelopmentAandAimplementationAofAstandardizedAhealthArelatedAfinancialA&Aadministrati
veAactivitiesAelectronically
2)AimplementationAofAprivacyA&AsecurityAproceduresAtoApreventAtheAmisuseAofAhealthAinfoAb
yAensuringAconfidentiality


WhatAisAtheAFalseAClaimsAActA(FCA)?A-
AAnswer✓AFederalAlawAthatAprohibitsAsubmittingAaAfraudulentAclaimAorAmakingAaAfalseA
statementAorArepresentationAinAconnectionAwithAaAclaim.AAlsoAprotectsA&ArewardsAwhistle-
blowers


WhatAisAtheANationalACorrectACodingAInitiativeA(NCCI)?A-
AAnswer✓ADevelopedAbyACMSAtoApromoteAtheAnationalAcorrectAcodingAmethodologiesA&At
oAcontrolAimproperAcodingAthatAleadAtoAinappropriateApaymentAofAPartABAhealthAinsurance
Aclaims


HowAmanyAeditsAdoesANCCIAinclude?A-AAnswer✓A2:A
1.ColumnA1/AColumnA2A(previouslyAcalledAComprehensive/AComponent)AEdits
A2.MutuallyAExclusiveAEdits


ColumnA1/AColumnA2AeditsA(NCCI)A-
AAnswer✓AIdentifiesAcodeApairsAthatAshouldAnotAbeAbilledAtogetherAbecauseA1AcodeA(Colu
mnA1)AincludesAallAtheAservicesAdescribedAbyAanotherAcodeA(ColumnA2)


MutuallyAExclusiveAEditsA(NCCI)A-
AAnswer✓AID'sAcodeApairsAthat,AforAclinicalAreasons,AareAunlikelyAtoAbeApreformedAonAt
heAsameApatientAonAtheAsameAday


WhatAareAtheApossibleAconsequencesAofAinaccurateAcodingAandAincorrectAbilling?A-
AAnswer✓AdelayedAprocessingA&ApaymentAofAclaims,AreducedApayments,AdeniedAclaimsAfi
neAandAorAimprisonment,AexclusionAfromApayer'sAprograms,AlossAofADr.'sAlicenseAtoApractic
eAmedicine


WhoAhasAtheAtaskAofAinvestigateAandAprosecutingAhealthAcareAfraudA&Aabuse?A-
AAnswer✓ATheAOfficeAofAInspectorAGeneralA(OIG)

,FraudA-
AAnswer✓AknowinglyA&AintentionallyAdeceivingAorAmisrepresentingAinfoAthatAmayAresultAi
nAunauthorizedAbenefits.AitAisAaAfelonyAandAcanAresultAinAfinesAandAorAprison


WhoAauditsAclaims?A-
AAnswer✓AStateA&AFederalAagenciesAasAwellAasAprivateAinsuranceAcompanies


WhatAareAcommonAformsAofAfraud?A-
AAnswer✓AbillingAforAservicesAnotAfurnished,Aunbundling,AandAmisrepresentingAdiagnosisA
toAjustifyApayment


AbuseA-
AAnswer✓AincidencesAorApractices,AnotAusuallyAconsideredAfraudulent,AthatAareAinconsiste
ntAwithAtheAacceptedAmedicalAbusinessAorAfiscalApracticesAinAtheAindustry


WhatAareAexamplesAofAAbuse?A-
AAnswer✓AsubmittingAaAclaimAforAservices/AproceduresAperformedAthatAisAnotAmedicallyA
necessary,AandAexcessiveAchargesAforAservices,AequipmentAorAsupplies


WhatAisAaAmethodAuseAtoAminimizeAdanger,AhazardsAandAliabilitiesAassociatedAwithAabuse?
A-AAnswer✓ARiskAManagement


PatientAConfidentialityA-
AAnswer✓AAllApatient'sAhaveArightAtoAprivacyAandAallAinfoAshouldAremainAprivileged.AOn
lyAdiscussApatientAinfoAwhenAnecessaryAtoAdoAjob.AObtainAaAsignedAconsentAformAtoAreleas
eAmedicalAinfoAtoAinsuranceAcompanyAorAotherAindividual


WhenAmayAaAproviderAuseAPHIA(ProtectedAHealthAInformation)AwithoutAspecificAauthorization
AunderAtheAHIPAAAPrivacyARule?A-
AAnswer✓AWhenAusingATPO,ATreatmentA(primarilyAforAtheApurposeAofAdiscussionAofApatie
nt'sAcaseAwithAotherADr's)A
PaymentA(providersAsubmitAclaimsAonAbehalfAofApatients)
OperationsA(forApurposesAsuchAasAtrainingAstaffAandAqualityAimprovement)


WhatAisAEmployerALiability?A-
AAnswer✓AMeansAphysiciansAareAlegallyAresponsibleAforAtheirAownAconductAandAanyAacti
onsAofAtheirAemployeesA(designee)AperformedAwithinAtheAcontextAofAtheirAemployment.ARefe

, rredAtoAasA"vicariousAliability"AA.K.AA"ArespondentAsuperior"-
A"letAtheAmasterAAnswer✓".AMeansAemployeeAcanAbeAsuedA&AbroughtAtoAtrial


WhatAisAEmployeeALiability?A-AAnswer✓A"ErrorsA&AOmissionsAInsurance"-
AprotectionAagainstAlossAofAmoniesAcausedAbyAfailureAthroughAerrorAorAunintentionalAomissi
onAonAtheApartAofAtheAindividualAorAserviceAsubmittingAtheAclaim.A***SomeADr.'sAcontractA
withAaAbillingAserviceA(clearinghouse)AtoAhandleAclaimsAsubmissionAandAsomeAagreementsAc
ontainAaAclauseAstatingAthatAtheADr.AwillAholdAtheAcoAharmlessAfromA"liabilityAresultingAfr
omAclaimsAsubmittedAbyAtheAserviceAforAanyAaccount",AmeansADr.AisAresponsibleAforAmista
kesAmadeAbyAbillingAservice,AerrorsAandAomissionsAisAnotAneededAinAtheAinstance.***
However,AifAtheADr.AeverAasksAtheAinsuranceAbillerAtoAdoAtheAleastAbitAquestionable,AsuchA
asAwriteAoffApatientsAbalancesAforAcertainApatientsAautomatically,AmakeAsureAyouAhaveAaAl
egalAdocumentAorAsignedAwaiverAofAliabilityArelievingAyouAofAresponsibilityAforAsuchAaction
s.


WhatAisAaAMedicalARecordA&AwhatAisAitAcomprisedAof?A-
AAnswer✓ADocumentationAofAtheApatientsAsocialAandAmedicalAhistory,AfamilyAhistory,Aphy
sicalAexamAfindings,AprogressAnotes,AradiologyAandAlabAresults,AconsultationAreportsAandAco
rrespondenceAtoApatients
IsAtheAforemostAtoolAofAclinicalAcareAandAcommunication


WhatAisAaAmedicalAreport?A-
AAnswer✓ApartAofAtheAmedicalArecordA&AisAaApermanentAlegalAdocumentAthatAformallyAs
tatesAtheAconsequencesAofAtheApatientsAexamAorAtreatmentAinAletterAorAreportAform
ITAISATHISARECORDATHATAPROVIDESAINFOANEEDEDATOACOMPLETEATHEAINSURANCEACLAIMAFO
RM


ReasonsAforADocumentationA-
AAnswer✓AImportantAthatAeveryApatientAseenAbyADr.AhasAcomprehensiveAlegibleAdocumen
tationAaboutApatientsAillness,AtreatmentAandAplansAforAfollowingAreasons:
*AAvoidanceAofAdeniedAorAdelayedApaymentAbyAinsuranceAcompanyAinvestigatingAtheAmedica
lAnecessityAofAservice
*AEnforcementAofAmedicalArecord-
keepingArulesAbyAinsuranceAcompany'sArequiringAaccurateAdocumentationAthatAsupportsAproc
edureA&AdiagnosisAcodes
*ASubpoenaAofAmedicalArecordsAbyAstateAinvestigatorsAorAtheAcourtAforAreview
*ADefenseAofAprofessionalAliabilityAclaim