Certification Examination Practice

Illinois Medical Billing Specialist Certification Examination Practice Questions And Correct Answers (Verified Answers) Plus Rationales 2026 Q&A | Instant Download Pdf

• What is the primary purpose of medical billing?
• To diagnose patients
• To schedule procedures
• To generate insurance claims for reimbursement
• To conduct medical research
• To generate insurance claims for reimbursement

Rationale: Medical billing is focused on claim submission and

securing payment from insurers and patients.

• What does CMS stand for?
• Center for Medical Systems
• Centers for Medicare & Medicaid Services 1 / 4

• Clinical Medical Services
• Central Medical Standardization
• Centers for Medicare & Medicaid Services

Rationale: CMS is the federal agency overseeing Medicare and

Medicaid programs and billing rules.

• Which form is commonly used for professional (non-hospital) medical

claims?

A. UB-04

B. 837-I

C. 1500

D. 1099

C. 1500

Rationale: The CMS-1500 form is used for physician and outpatient

medical claims.

• Which code set describes medical procedures and services?

A. ICD-10-CM

B. CPT

• HCPCS Level II

D. DRG

B. CPT

Rationale: CPT codes are used to document procedures performed by

healthcare providers. 2 / 4

5. ICD-10-CM codes are used for:

• Procedures
• Supply billing
• Diagnoses
• Hospital equipment
• Diagnoses

Rationale: ICD-10-CM represents classification for diagnostic

purposes.

6. A deductible is:

• The amount the insurance company pays first
• The amount the patient must pay before insurance coverage begins
• The fee paid to the provider after service is complete
• The denied portion of a claim
• The amount the patient must pay before insurance coverage

begins

Rationale: Patients must meet their deductible before insurance

shares responsibility for payments.

• Which of the following programs is primarily for low-income

individuals?

• Medicare
• Medicaid

C. TRICARE

• Workers’ Compensation 3 / 4

• Medicaid

Rationale: Medicaid is state-administered and supports low-income

and certain eligible populations.

• Which part of Medicare covers physician office visits?
• Part A
• Part B
• Part C
• Part D
• Part B

Rationale: Medicare Part B covers outpatient and physician service

claims.

9. The UB-04 form is used for:

• Physician claims
• Durable medical equipment
• Hospital facility billing
• Dental claims
• Hospital facility billing

Rationale: UB-04 is used by hospitals and institutional providers.

• A claim rejected due to incorrect patient information is

considered:

• Paid
• Pending
• Denied
• / 4