WGU D366 FINAL TEST 2026 QUESTIONS
WITH CORRECT ANSWERS GRADED A+
◍ 3. How does the life cycle of a medical bill begin?.
Answer: C. A Completed Questionnaire
◍ A billing and coding specialist is reviewing a remittance advice for a claim
that was denied for medical necessity. Which of the following is an example
of this type of error?- The preauthorization for an appendectomy was not
obtained.- The patient's current demographic information was not entered
correctly on the claim form.- The ICD-10-0M code for tonsillitis was listed
with the CPT® code for an appendectomy- Appendectomies are not covered
by the patient's insurance plan..
Answer: The ICD-10-0M code for tonsillitis was listed with the CPT® code
for an appendectomyThe diagnosis code must provide the reason the
procedure was performed and the treatment provided must be medically
necessary for the listed condition.
◍ 13. When an insurance carrier pays for medical treatment based on a policy,
it is paying _____..
Answer: A. Benefits
◍ 14. This is the process of paying someone for services already performed..
Answer: A. Reimbursement
◍ 18. Which claim form is usually submitted for services performed in a
physician's office?.
Answer: B. CMS-1500
◍ 17. Who is the second party?.
Answer: D. Physician, Clinic or Hospital
◍ Which of the following does a patient sign to allow payment of claims
, directly to the provider?- Advance Beneficiary Notice (ABN)- Assignment
of benefits statement- Notice of Privacy Practices (NPP)- release of
information form.
Answer: Assignment of Benefits statementthe patient signs an assignment of
benefits statement to allow payment of claims directly to the provider
◍ 16. What is another term for insurance carrier?.
Answer: C. Insurance Company
◍ 19. A program that pays the medical bills for people with job-related injuries
or illnesses is called what?.
Answer: D. Workers' Compensation
◍ 9. This process includes notifying the insurance company for approval prior
to a procedure..
Answer: C. Preauthorization
◍ A patient is covered by Medicare through managed care. Which of the
following parts of Medicare includes this coverage?- Part A- Part B- Part C-
Part D.
Answer: Part CPart A covers inpatient services and facility expensesPart B
covers professional services, including outpatient care and provider
costsPart C covers Medicare Advantage Plans, which are administered by
private insurers and can include managed care plansPart D Medicare Part D
covers pharmacy expenses
◍ 12. This is the healthcare program for the Department of Defense..
Answer: B. TRICARE
◍ A patient has health coverage through multiple third-party payers. A billing
and coding specialist should identify that which of the following is the payer
of last resort?- Medicaid- CHAMPVA- Medicare- TRICARE.
Answer: MedicaidMedicaid is the health plan that is referred to as the payer
of last resort. All of the patient's health plans must meet their obligations
before Medicaid will pay.
◍ 5. If preauthorization is required, but the insurance company is not notified,
, the insurance company _____..
Answer: B. Might Reduce Reimbursement
◍ NOTE TO THE STUDIER:.
Answer: BE SURE TO CHECK THAT THE ANSWER CHOICES HAVE
NOT CHANGED LETTERS AND THAT THE QUESTIONS HAVE NOT
SWITCHED ORDER. CAREFULLY LOOK OVER EVERYTHING
BEFORE SUBMITTING YOUR ANSWERS.
◍ A patient was seen in an outpatient clinic for a cough, chest congestion, and
a low-grade fever and was given the diagnosis of possible pneumonia. How
should a billing and coding specialist code this encounter using
ICD-10-CM?- cough, fever, pneumonia- pneumonia - cough, chest
congestion, and a low-grade fever- possible pneumonia.
Answer: cough, chest congestion, and a low-grade feverin an outpatient
setting, the specialist should code the patient's symptoms when there is no
confirmed diagnoses.
◍ 4. What is the total amount of bills at which point the copayment is dropped
called?.
Answer: C. Threshold Limit
◍ 20. This is a document that explains how much the insurance company paid
on a claim..
Answer: D. Explanation of benefits
◍ Which of the following statements is true when determining patient
financial responsibility by reviewing the remittance advice?- Any services
denied for erroneous claim data are the responsibility of the patient.- Any
coinsurance, copayments, or deductibles should be collected from the
patient.- the difference between the billed and the allowed amount should be
collected from the patient.- claims not billed to a third party payer within the
correct time period should be collected from the patient..
Answer: Any coinsurance, copayments, or deductibles should be collected
from the patient.the coinsurance, copayment, and deductible are all
responsibilities of the patient.
WITH CORRECT ANSWERS GRADED A+
◍ 3. How does the life cycle of a medical bill begin?.
Answer: C. A Completed Questionnaire
◍ A billing and coding specialist is reviewing a remittance advice for a claim
that was denied for medical necessity. Which of the following is an example
of this type of error?- The preauthorization for an appendectomy was not
obtained.- The patient's current demographic information was not entered
correctly on the claim form.- The ICD-10-0M code for tonsillitis was listed
with the CPT® code for an appendectomy- Appendectomies are not covered
by the patient's insurance plan..
Answer: The ICD-10-0M code for tonsillitis was listed with the CPT® code
for an appendectomyThe diagnosis code must provide the reason the
procedure was performed and the treatment provided must be medically
necessary for the listed condition.
◍ 13. When an insurance carrier pays for medical treatment based on a policy,
it is paying _____..
Answer: A. Benefits
◍ 14. This is the process of paying someone for services already performed..
Answer: A. Reimbursement
◍ 18. Which claim form is usually submitted for services performed in a
physician's office?.
Answer: B. CMS-1500
◍ 17. Who is the second party?.
Answer: D. Physician, Clinic or Hospital
◍ Which of the following does a patient sign to allow payment of claims
, directly to the provider?- Advance Beneficiary Notice (ABN)- Assignment
of benefits statement- Notice of Privacy Practices (NPP)- release of
information form.
Answer: Assignment of Benefits statementthe patient signs an assignment of
benefits statement to allow payment of claims directly to the provider
◍ 16. What is another term for insurance carrier?.
Answer: C. Insurance Company
◍ 19. A program that pays the medical bills for people with job-related injuries
or illnesses is called what?.
Answer: D. Workers' Compensation
◍ 9. This process includes notifying the insurance company for approval prior
to a procedure..
Answer: C. Preauthorization
◍ A patient is covered by Medicare through managed care. Which of the
following parts of Medicare includes this coverage?- Part A- Part B- Part C-
Part D.
Answer: Part CPart A covers inpatient services and facility expensesPart B
covers professional services, including outpatient care and provider
costsPart C covers Medicare Advantage Plans, which are administered by
private insurers and can include managed care plansPart D Medicare Part D
covers pharmacy expenses
◍ 12. This is the healthcare program for the Department of Defense..
Answer: B. TRICARE
◍ A patient has health coverage through multiple third-party payers. A billing
and coding specialist should identify that which of the following is the payer
of last resort?- Medicaid- CHAMPVA- Medicare- TRICARE.
Answer: MedicaidMedicaid is the health plan that is referred to as the payer
of last resort. All of the patient's health plans must meet their obligations
before Medicaid will pay.
◍ 5. If preauthorization is required, but the insurance company is not notified,
, the insurance company _____..
Answer: B. Might Reduce Reimbursement
◍ NOTE TO THE STUDIER:.
Answer: BE SURE TO CHECK THAT THE ANSWER CHOICES HAVE
NOT CHANGED LETTERS AND THAT THE QUESTIONS HAVE NOT
SWITCHED ORDER. CAREFULLY LOOK OVER EVERYTHING
BEFORE SUBMITTING YOUR ANSWERS.
◍ A patient was seen in an outpatient clinic for a cough, chest congestion, and
a low-grade fever and was given the diagnosis of possible pneumonia. How
should a billing and coding specialist code this encounter using
ICD-10-CM?- cough, fever, pneumonia- pneumonia - cough, chest
congestion, and a low-grade fever- possible pneumonia.
Answer: cough, chest congestion, and a low-grade feverin an outpatient
setting, the specialist should code the patient's symptoms when there is no
confirmed diagnoses.
◍ 4. What is the total amount of bills at which point the copayment is dropped
called?.
Answer: C. Threshold Limit
◍ 20. This is a document that explains how much the insurance company paid
on a claim..
Answer: D. Explanation of benefits
◍ Which of the following statements is true when determining patient
financial responsibility by reviewing the remittance advice?- Any services
denied for erroneous claim data are the responsibility of the patient.- Any
coinsurance, copayments, or deductibles should be collected from the
patient.- the difference between the billed and the allowed amount should be
collected from the patient.- claims not billed to a third party payer within the
correct time period should be collected from the patient..
Answer: Any coinsurance, copayments, or deductibles should be collected
from the patient.the coinsurance, copayment, and deductible are all
responsibilities of the patient.
