Free MCBC Practice Questions

Question 1

An in-network practice bills $300 for a covered office visit. The insurer allows $200. The patient has $50 of deductible remaining, then owes 20% coinsurance, with $500 remaining before the out-of-pocket maximum. There is no copay or secondary insurance. A $20 payment has already been credited to this visit. How much more may the practice collect from the patient?

Accepted Answer

$60

Answer

$70

Answer

$80

Answer

$160

Question 2

A patient remains in hospital observation status for 26 hours and is never admitted as an inpatient. The discharge documentation states, 'Epigastric pain; possible gastritis.' No definitive cause is established. Which approach to diagnosis reporting is supported for the hospital claim?

Accepted Answer

Report epigastric pain without coding gastritis as confirmed.

Answer

Apply inpatient rules and report gastritis as established.

Answer

Report both gastritis and epigastric pain as confirmed diagnoses.

Answer

Hold the claim until a follow-up visit establishes a definitive diagnosis.

Question 3

A cardiologist treating a patient requests the patient's recent ECG and medication list from the primary care practice. Staff verify the cardiologist's identity, treatment relationship, and secure destination. No additional legal restriction applies, but the patient has not signed a separate authorization for this disclosure. How should the practice respond under the HIPAA Privacy Rule?

Accepted Answer

Send the requested treatment records through the verified secure channel.

Answer

Obtain the patient's signed authorization before releasing the records.

Answer

Release only de-identified records to the outside cardiologist.

Answer

Require a business associate agreement between the two treating practices before release.

Question 4

A retired 68-year-old has Medicare based on age and group health coverage through a spouse who currently works for a private employer with 75 employees. The employer sponsors its own group plan. For a covered office visit, which insurer is primary?

Accepted Answer

The employer plan, because coverage is through the spouse's current employment.

Answer

Medicare, because the patient is retired and older than 65.

Answer

Medicare, because the patient's own coverage precedes coverage as a spouse's dependent.

Answer

The employer plan, but only after Medicare has denied the claim.

Question 5

After forgetting that he took his morning antihypertensive, a patient takes a second dose. The emergency physician documents an accidental overdose causing drug-induced hypotension and actively treats the patient. Select the coding sequence that matches this event.

Accepted Answer

Accidental drug-poisoning code first, followed by drug-induced hypotension.

Answer

Drug-induced hypotension, then the drug's adverse-effect code.

Answer

Drug-induced hypotension first, followed by the accidental drug-poisoning code.

Answer

The drug's adverse-effect code first, followed by drug-induced hypotension.

Question 6

An electronic claim file receives an accepted 999 acknowledgment. The subsequent 277CA rejects one claim for an invalid subscriber identifier. The biller verifies the correct identifier with the payer. What should happen next?

Accepted Answer

Resubmit the claim with the verified identifier and check its acceptance.

Answer

Appeal the rejection and attach proof of active coverage.

Answer

Wait for the remittance advice because the accepted 999 confirms claim acceptance.

Answer

Send a replacement claim linked to the original adjudication.

Question 7

At an established patient's office visit, the physician addresses hypertension and hyperlipidemia, both stable at treatment goals. After evaluating control and adverse effects, the physician documents a decision to continue both prescription regimens. Data review is limited to one lipid panel, with no other qualifying data activity. The E/M level is selected by medical decision making, not time. Which code is supported?

Accepted Answer

99214 - moderate medical decision making

Answer

99212 - straightforward medical decision making

Answer

99213 - low medical decision making

Answer

99215 - high medical decision making

Question 8

During a billing call, a patient at home says, 'I have new pressure in my chest that is not going away, and I suddenly feel short of breath.' The patient is alert and able to use the telephone. Which reply takes priority?

Accepted Answer

'Call 911 now; do not drive yourself.'

Answer

'I will mark a message urgent for the nurse to return your call.'

Answer

'Please have someone take you to the nearest urgent care center.'

Answer

'Tell me how severe the pressure is so I can decide whether you need emergency care.'

Question 9

Before releasing an injectable-drug charge, a biller reconciles these entries:

Original order: 60 mg.
Signed revised order, entered before administration: 30 mg.
Medication administration record: 30 mg given from one 40-mg vial.
HCPCS descriptor: 10 mg per billing unit.

How many HCPCS units belong on the administered-drug line, excluding any separately reported waste?

Accepted Answer

3 units

Answer

1 unit

Answer

4 units

Answer

6 units

Question 10

Before a nonurgent test that Medicare normally covers, the office expects a medical-necessity denial and delivers a valid, service-specific Advance Beneficiary Notice of Noncoverage. The Original Medicare patient selects Option 1: receive the service and have Medicare billed. The test is performed. Choose the appropriate claim handling.

Accepted Answer

Submit the Medicare claim with modifier GA.

Answer

Submit the Medicare claim with modifier GZ.

Answer

Submit the Medicare claim with modifier GY.

Answer

Bill the patient without submitting a Medicare claim.

Free MCBC Practice Questions

Domain 1: Professionalism, Ethics and Compliance 20% of exam

Question 1

Question 2

Domain 2: Medical Coding 30% of exam

Question 3

Question 4

Question 5

Domain 3: Medical Insurance 15% of exam

Question 6

Question 7

Domain 4: Billing and Reimbursement 35% of exam

Question 8

Question 9

Question 10

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