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CBCS Exam Study Guide Questions and
Answers 2026 Latest Update
Medical Billing & Coding as a Career Ans: Claims assistant
professional or claims manager, Coding Specialist, Collection
Manager, Electronic Claims Processor, Insurance Billing Specialist,
Insurance Coordinator, Insurance Counselor, Medical Biller,
Medical & Financial Records Manager, Billing & Coding Specialist
What are Medical Ethics? Ans: Standards of conduct based on
moral principle. They are generally accepted as a guide for
behavior towards pt's, dr's, co-workers, the gov, and ins co's.
What does acting within ethical behavior boundaries mean? Ans:
carrying out one's responsibilities w/ integrity, dignity, respect,
honesty, competence, fairness, & trust.
Legal Aspects of of Medical Billing & Coding: Ans: ...
Compliance regulations: Ans: Most billing-related cases are based
on HIPPA and False Claims Act
Health Insurance Portability & Accountability Act (HIPPA) Ans:
Enacted in 1996, created by the Health Care Fraud & Abuse Control
Program-enacted to check for fraud and abuse in the
Medicare/Medicaid Programs and private payers
What are the 2 provisions of HIPPA? Ans: Title I: Insurance Reform
Title II: Administrative Simplification
© 2025 All rights reserved
, 2 | Page
What is Title I of HIPPA? Ans: Insurance Reform-primary purpose
is to provide continuous ins coverage for worker & their
dependents when they change or lose jobs. Also Limits the use of
preexisting conditions exclusions Prohibits discrimination from
past or present poor health Guarantees certain employees/indv
the right to purchase new health ins coverage after losing job
Allows renewal of health ins cov regardless of an indv's health
cond. that is covered under the particular policy.
What is Title II of HIPPA? Ans: Administrative Simplification-goal
is to focus on the health care practice setting to reduce
administrative cost & burdens. Has 2 parts- 1) development and
implementation of standardized health-related financial &
administrative activities electronically 2) Implementation of
privacy & security procedures to prevent the misuse of health info
by ensuring confidentiality
What is the False Claims Act (FCA)? Ans: Federal law that prohibits
submitting a fraudulent claim or making a false statement or
representation in connection w/ a claim. Also protects & rewards
whistle-blowers.
What is the National Correct Coding Initiative (NCCI)? Ans:
Developed by CMS to promote the national correct coding
methodologies & to control improper coding that lead to
inappropriate payment of Part B health ins claims.
How many edits does NCCI include? Ans: 2: 1)Column 1/Column 2
(prev called Comprehensive/Component) Edits
2) Mutually Exclusive Edits
© 2025 All rights reserved
CBCS Exam Study Guide Questions and
Answers 2026 Latest Update
Medical Billing & Coding as a Career Ans: Claims assistant
professional or claims manager, Coding Specialist, Collection
Manager, Electronic Claims Processor, Insurance Billing Specialist,
Insurance Coordinator, Insurance Counselor, Medical Biller,
Medical & Financial Records Manager, Billing & Coding Specialist
What are Medical Ethics? Ans: Standards of conduct based on
moral principle. They are generally accepted as a guide for
behavior towards pt's, dr's, co-workers, the gov, and ins co's.
What does acting within ethical behavior boundaries mean? Ans:
carrying out one's responsibilities w/ integrity, dignity, respect,
honesty, competence, fairness, & trust.
Legal Aspects of of Medical Billing & Coding: Ans: ...
Compliance regulations: Ans: Most billing-related cases are based
on HIPPA and False Claims Act
Health Insurance Portability & Accountability Act (HIPPA) Ans:
Enacted in 1996, created by the Health Care Fraud & Abuse Control
Program-enacted to check for fraud and abuse in the
Medicare/Medicaid Programs and private payers
What are the 2 provisions of HIPPA? Ans: Title I: Insurance Reform
Title II: Administrative Simplification
© 2025 All rights reserved
, 2 | Page
What is Title I of HIPPA? Ans: Insurance Reform-primary purpose
is to provide continuous ins coverage for worker & their
dependents when they change or lose jobs. Also Limits the use of
preexisting conditions exclusions Prohibits discrimination from
past or present poor health Guarantees certain employees/indv
the right to purchase new health ins coverage after losing job
Allows renewal of health ins cov regardless of an indv's health
cond. that is covered under the particular policy.
What is Title II of HIPPA? Ans: Administrative Simplification-goal
is to focus on the health care practice setting to reduce
administrative cost & burdens. Has 2 parts- 1) development and
implementation of standardized health-related financial &
administrative activities electronically 2) Implementation of
privacy & security procedures to prevent the misuse of health info
by ensuring confidentiality
What is the False Claims Act (FCA)? Ans: Federal law that prohibits
submitting a fraudulent claim or making a false statement or
representation in connection w/ a claim. Also protects & rewards
whistle-blowers.
What is the National Correct Coding Initiative (NCCI)? Ans:
Developed by CMS to promote the national correct coding
methodologies & to control improper coding that lead to
inappropriate payment of Part B health ins claims.
How many edits does NCCI include? Ans: 2: 1)Column 1/Column 2
(prev called Comprehensive/Component) Edits
2) Mutually Exclusive Edits
© 2025 All rights reserved
