BILLING AND CODING BUNDLED
COMPREHENSIVE REVIEW 2026 COMPLETE
QUESTIONS AND CORRECT ANSWERS
GRADED A+
◉ explanation of benefits (EOB).
Answer: A summary of coverage provided by an insurer to the
subscriber and the healthcare provider after an insurance claim is
made, including what portion of the charges are covered by
insurance and what portion must be paid by the patient.
◉ remittance advice (RA) statement.
Answer: A document provided by an insurer to a healthcare
provider summarizing a health insurance claim, including charges
that have been billed, what portion are covered by insurance, and
what portion must be paid by the patient.
◉ allowable amount.
Answer: A standard fee for a treatment, service, or supply set by an
insurer; providers contracted with an insurer are obliged to accept
this amount as payment.
◉ rider.
, Answer: Something added to an insurance policy that changes the
terms of the policy, for example to add specific additional coverage.
◉ indemnity plan.
Answer: A type of health insurance in which the subscriber can
choose any provider or facility for health care and receive
reimbursement based on billed costs as long as the charges are
considered usual, customary, and reasonable; sometimes called a
fee-for-service plan.
◉ managed care.
Answer: A system or strategy of managing health care in a way that
controls costs.
◉ gatekeeper.
Answer: Term sometimes used to describe a primary care provider;
refers to the provider's role in managing a patient's access to
healthcare services.
◉ health maintenance organization (HMO).
Answer: A form of health insurance in which the cost of care is
covered only when a person uses a particular doctor or group of
doctors except in case of emergency; seeing specialists generally
requires referrals from a primary care provider.
COMPREHENSIVE REVIEW 2026 COMPLETE
QUESTIONS AND CORRECT ANSWERS
GRADED A+
◉ explanation of benefits (EOB).
Answer: A summary of coverage provided by an insurer to the
subscriber and the healthcare provider after an insurance claim is
made, including what portion of the charges are covered by
insurance and what portion must be paid by the patient.
◉ remittance advice (RA) statement.
Answer: A document provided by an insurer to a healthcare
provider summarizing a health insurance claim, including charges
that have been billed, what portion are covered by insurance, and
what portion must be paid by the patient.
◉ allowable amount.
Answer: A standard fee for a treatment, service, or supply set by an
insurer; providers contracted with an insurer are obliged to accept
this amount as payment.
◉ rider.
, Answer: Something added to an insurance policy that changes the
terms of the policy, for example to add specific additional coverage.
◉ indemnity plan.
Answer: A type of health insurance in which the subscriber can
choose any provider or facility for health care and receive
reimbursement based on billed costs as long as the charges are
considered usual, customary, and reasonable; sometimes called a
fee-for-service plan.
◉ managed care.
Answer: A system or strategy of managing health care in a way that
controls costs.
◉ gatekeeper.
Answer: Term sometimes used to describe a primary care provider;
refers to the provider's role in managing a patient's access to
healthcare services.
◉ health maintenance organization (HMO).
Answer: A form of health insurance in which the cost of care is
covered only when a person uses a particular doctor or group of
doctors except in case of emergency; seeing specialists generally
requires referrals from a primary care provider.
