Certified Professional Coding Test questions and answers GRADED A
Coding is Correct Answer: the process of translating this written or dictated medical record into a series
of numeric or alpha-numeric codes
Proper code assignment is determined by Correct Answer: content of the medical record and by the
unique rules that governs each code set
What are 3 things that Coder must master Correct Answer: 1. anatomy
2. medical terminology
3. must be detail-oriented
Medical coders assign a code to what Correct Answer: 1. Each diagnosis
2. Service/procedure
3. Supply, using the classification system when applicable
The classification system determines ______ Correct Answer: the amount health care providers will be
reimbursed if the patient is covered by Medicare, Medicaid, or other insurance programs using the
system
A coder must evaluate the medical record for Correct Answer: 1. completeness and accuracy
2. communicate regularly with physicians and the health care professional to clarify DX or obtain
additional PT info.
Techicians who speciallize in coding inpatient hospital services are referred as Correct Answer: 1. Health
information coders
2. medical record coders
3. Coder/abstractors
4. Coding Specialist
What is MS-DRGs and what does it do? Correct Answer: 1. Medicare Severity-Diagnosis Related Groups
2. Determines the amt the hospital will be reimbursed if the PT is covered by Medicare or other
insurance programs
What is EHR Correct Answer: Electronic health record
Skilled coders may become Correct Answer: consulatants, educators or medical auditors
What is the difference between Hospital and Physican Services Correct Answer: 1. Outpatient coding
(physician services)- learning CPT, HCPCS, LEVEL II, ICD-9 CM codes Volume 1 and 2
2. Inpatient coding (Hospital services)- Learning CPT, ICD-9 CM codes Volumes 1,2,3 and MS-DRGS
What is APC and who uses it Correct Answer: Ambulatory Payment Classification- outpatient facility
coders (physician services
,What is the coder's role in a physician's office Correct Answer: Extremely important for the proper
reimbursement of services and the livelihood of the physician
What is a physican degree of education Correct Answer: 4 years of college, 4 years of medical school
plus 3 to 5 years of residency.
What are mid-level providers and who can be classified as one? Correct Answer: 1. Mid-level providers
are know as physician extenders
2. Physician assistants (PA) and Nurse Practitioners (NP)
What are the requirement for a PA and what Correct Answer: 1. 26 1/2 month program to complete
2. Licensed to practice medicine under physician supervision
NP must have Correct Answer: A Master's Degree in Nursing
In simplest terms, how many payers are there? Correct Answer: 2
Private insurance plans and government insurance plans
Commercial carriers are considered what Correct Answer: Private payers that offer both group and
individual plans.
Private Payers contracts may vary but may include _____ Correct Answer: hospitalization, basic, and
major medical coverage.
What is the most significant government insurer Correct Answer: Medicare
What is Medicare Correct Answer: Federal health insurance program- Administered by the Center for
Medicare & Medicaid Services (CMS)
What is CMS and what does it provide Correct Answer: Center for Medicare & Medicaid Services (CMS)
provides coverage for people over the age of 65, blind, or disabled individuals, people with end -stage
renal disease
CMS regulations often serves as the____ word in coding requirement for Medicare and Non-Medicare
payers alike Correct Answer: Last
What are the parts of Medicare Correct Answer: Medicare A
Medicare B
Medicare C
Medicare D
What is Medicare Part A? Correct Answer: Covers inpatient hospital care, as well as care provided in
skilled nursing facilites, hospice care, and home health care
What is Medicare Part B? Correct Answer: Covers medically necessary doctors' services, outpatient
care, other medical services (including some preventive service not covered under Medicare Part A)
, Medicare Part B is considered what? Correct Answer: A optional benefit for which the patient must pay
a premium and which generally requires a yearly copay
Where is Medicare Part B usually used Correct Answer: Physician offices (Outpatient Facility)
What is Medicare Part C Correct Answer: Combines the benefits of Medicare Part A, Part B, and
sometimes Part D.
What is Medicare Part C also called Correct Answer: Medicare Advantage
What is PPO Correct Answer: Preferred Provider Organizations
What is HMO Correct Answer: Health Maintenace Organizations
Which plan covers PPO and HMO Correct Answer: Medicare Part C
What is the CMS-HCC Correct Answer: Center for Medicare & Medicaid Services-Hierarchical condition
category
What does the CMS-HCC provide Correct Answer: Risk adjument model provides adjusted payment
based on a patient's disease and demographic factors.
If a coder does not include all pertinent diagnoses and co-morbidities, the provider may lose out on
what Correct Answer: additional reimbursement for which he/she is entitled.
What is Medicare Part D Correct Answer: Prescription drug coverage program available to all Medicare
beneficiaries. Private companies approved by Medicare provide the coverage.
What is Medicaid Correct Answer: A health insurance assistance program for some low income people
(especially children and pregnant women) sponsored by federal and state governments
Medicaid is administered on___________ Correct Answer: a state-by-state basis and coverage varies-
although each of the state programs adheres to certain federal guidelines
When is a physican considered a "participating physician" Correct Answer: When contracted with a
insurance carrier whether that be a private insurance company or a governmental.
Participating Providers (Par Providers) are required to accept__________________ Correct Answer: the
allowed payment amount determined by the insurance carrier as the fee for payment and follow all
other guidelines stipulated by the contract
The difference between the physican's fee and the insurance carriers allowed amount is Correct Answer:
adjusted by the participating provider
Non-participating Providers (non par) are? Correct Answer: 1. providers not contracted with the
insurance carriers
2. not required to make the adjustment
Coding is Correct Answer: the process of translating this written or dictated medical record into a series
of numeric or alpha-numeric codes
Proper code assignment is determined by Correct Answer: content of the medical record and by the
unique rules that governs each code set
What are 3 things that Coder must master Correct Answer: 1. anatomy
2. medical terminology
3. must be detail-oriented
Medical coders assign a code to what Correct Answer: 1. Each diagnosis
2. Service/procedure
3. Supply, using the classification system when applicable
The classification system determines ______ Correct Answer: the amount health care providers will be
reimbursed if the patient is covered by Medicare, Medicaid, or other insurance programs using the
system
A coder must evaluate the medical record for Correct Answer: 1. completeness and accuracy
2. communicate regularly with physicians and the health care professional to clarify DX or obtain
additional PT info.
Techicians who speciallize in coding inpatient hospital services are referred as Correct Answer: 1. Health
information coders
2. medical record coders
3. Coder/abstractors
4. Coding Specialist
What is MS-DRGs and what does it do? Correct Answer: 1. Medicare Severity-Diagnosis Related Groups
2. Determines the amt the hospital will be reimbursed if the PT is covered by Medicare or other
insurance programs
What is EHR Correct Answer: Electronic health record
Skilled coders may become Correct Answer: consulatants, educators or medical auditors
What is the difference between Hospital and Physican Services Correct Answer: 1. Outpatient coding
(physician services)- learning CPT, HCPCS, LEVEL II, ICD-9 CM codes Volume 1 and 2
2. Inpatient coding (Hospital services)- Learning CPT, ICD-9 CM codes Volumes 1,2,3 and MS-DRGS
What is APC and who uses it Correct Answer: Ambulatory Payment Classification- outpatient facility
coders (physician services
,What is the coder's role in a physician's office Correct Answer: Extremely important for the proper
reimbursement of services and the livelihood of the physician
What is a physican degree of education Correct Answer: 4 years of college, 4 years of medical school
plus 3 to 5 years of residency.
What are mid-level providers and who can be classified as one? Correct Answer: 1. Mid-level providers
are know as physician extenders
2. Physician assistants (PA) and Nurse Practitioners (NP)
What are the requirement for a PA and what Correct Answer: 1. 26 1/2 month program to complete
2. Licensed to practice medicine under physician supervision
NP must have Correct Answer: A Master's Degree in Nursing
In simplest terms, how many payers are there? Correct Answer: 2
Private insurance plans and government insurance plans
Commercial carriers are considered what Correct Answer: Private payers that offer both group and
individual plans.
Private Payers contracts may vary but may include _____ Correct Answer: hospitalization, basic, and
major medical coverage.
What is the most significant government insurer Correct Answer: Medicare
What is Medicare Correct Answer: Federal health insurance program- Administered by the Center for
Medicare & Medicaid Services (CMS)
What is CMS and what does it provide Correct Answer: Center for Medicare & Medicaid Services (CMS)
provides coverage for people over the age of 65, blind, or disabled individuals, people with end -stage
renal disease
CMS regulations often serves as the____ word in coding requirement for Medicare and Non-Medicare
payers alike Correct Answer: Last
What are the parts of Medicare Correct Answer: Medicare A
Medicare B
Medicare C
Medicare D
What is Medicare Part A? Correct Answer: Covers inpatient hospital care, as well as care provided in
skilled nursing facilites, hospice care, and home health care
What is Medicare Part B? Correct Answer: Covers medically necessary doctors' services, outpatient
care, other medical services (including some preventive service not covered under Medicare Part A)
, Medicare Part B is considered what? Correct Answer: A optional benefit for which the patient must pay
a premium and which generally requires a yearly copay
Where is Medicare Part B usually used Correct Answer: Physician offices (Outpatient Facility)
What is Medicare Part C Correct Answer: Combines the benefits of Medicare Part A, Part B, and
sometimes Part D.
What is Medicare Part C also called Correct Answer: Medicare Advantage
What is PPO Correct Answer: Preferred Provider Organizations
What is HMO Correct Answer: Health Maintenace Organizations
Which plan covers PPO and HMO Correct Answer: Medicare Part C
What is the CMS-HCC Correct Answer: Center for Medicare & Medicaid Services-Hierarchical condition
category
What does the CMS-HCC provide Correct Answer: Risk adjument model provides adjusted payment
based on a patient's disease and demographic factors.
If a coder does not include all pertinent diagnoses and co-morbidities, the provider may lose out on
what Correct Answer: additional reimbursement for which he/she is entitled.
What is Medicare Part D Correct Answer: Prescription drug coverage program available to all Medicare
beneficiaries. Private companies approved by Medicare provide the coverage.
What is Medicaid Correct Answer: A health insurance assistance program for some low income people
(especially children and pregnant women) sponsored by federal and state governments
Medicaid is administered on___________ Correct Answer: a state-by-state basis and coverage varies-
although each of the state programs adheres to certain federal guidelines
When is a physican considered a "participating physician" Correct Answer: When contracted with a
insurance carrier whether that be a private insurance company or a governmental.
Participating Providers (Par Providers) are required to accept__________________ Correct Answer: the
allowed payment amount determined by the insurance carrier as the fee for payment and follow all
other guidelines stipulated by the contract
The difference between the physican's fee and the insurance carriers allowed amount is Correct Answer:
adjusted by the participating provider
Non-participating Providers (non par) are? Correct Answer: 1. providers not contracted with the
insurance carriers
2. not required to make the adjustment
