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NHA REVIEW ASSESSMENT 3 CERTIFIED BILLING AND CODING SPECIALIST, CBCS
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NHA REVIEW ASSESSMENT 3CERTIFIED BILLING AND CODING SPECIALIST, CBCS
NAME: Score:
For each of the following questions, please circle the letter of the most appropriate response.
1. CPT codes are:
a. Divided into I, II and III groupings
b. Required on submitted claims
c. Published and released January 1st of every year
d. All of the above are correct
2. Which of the following statements best describes the term, “allowed amount”?
a. The amount of reimbursement an insurance payer and patient agree to pay a provider
b. The amount allowed by the provider for supplies
c. The difference between what has been paid by the patient and the amount billed
d. The difference between the patient’s copayment and what is owed according to
the EOB.
3. HCPCS:
a. Is an acronym meaning, Healthcare Common Procedure Coding System
b. Is divided into two levels: Level I, CPT codes and Level II, National Codes
c. Level I codes are maintained by the AMA and Level II codes are maintained by
CMS d. All of the above are correct
4. When a billing and coding specialist submits a patient’s claim for a surgical procedure and
the insurance company does not require further review to make payment, this is an example
of:
a. A rejected
claim b. A clean
claim
c. An incomplete claim
d. A pending claim
5. A billing and coding specialist should make the following a priority action in order to
identify areas of risk associated with billing compliance:
a.Conduct educational training
b. Designate a security officer to monitor compliance
c.Develop external audit procedures
d. Perform internal audits to monitor the billing process
, NAME:
6. The organization responsible for conducting investigations and audits when questions
of breaches of protected health information arise is:
a. HIPAA
b. OCR
c. OIG
d. All of the above are correct.
7. A billing and coding specialist enters, 99211 on the CMS1500 claim form and got this code
from:
a. HCPCS
b. CPT manual
c. ICD manual
d. NPI
8. ICD-10-CM is viewed as an improvement from ICD-9-CM because:
a. It contains new chapters and categories
b. The V and E codes have been incorporated into the main classification system
c. The codes are more specific and therefore provide more information
d. All of the above are correct
9. The following is required if a procedure might not be covered by Medicare:
a. ABN
b. COB
c. CMS
d. AOB
10. In the charge capture process, a billing and coding specialist needs to verify code linkage
to ensure:
a. Correct encounter documentation
b. Claim scrubbing
c. Medical necessity
d. Allowed amount for procedures
11. If this is missing from a claim form, it can delay
processing: a. Secondary insurance
b. Medical record number
c. Units of service
d. Telephone number
2|Pa ge
, NAME:
12. Category I CPT codes are:
a. No longer used to code patient procedures
b. Five digit codes and two digit modifiers
c. Primarily used to indicate physicians’ services but are used for hospital outpatient coding
too
d. Both b and c are correct
13. Category II CPT codes:
a. Were designed to serve as supplemental tracking codes that can be used for
performance measurement
b. Are mandatory on all submitted claims
c. Are used for procedures done in an acute care setting
d. Both a and b are correct
14. In order to release documentation to a third party payer, this form must be signed:
a. Confidentiality consent
b. Release of insurance
c. Implied consent
d. Release of information
15. The first step in the life cycle of a claim is:
a. Receiving reimbursement
b. Collecting insurance information
c. Charge entry
d. Printing a superbill
16. The CMS-1500 claim form is used for:
a. Hospital inpatient claims
b. Ambulatory services claims
c. Office outpatient claims
d. All of the above are correct.
17. Category III CPT codes:
a. Indicate if a service is medically necessary
b. Are tracking codes used for performance measures
c. Are used for temporary coding for new technology and services that have not met the
requirements needed to be added to the main section of the CPT manual
d. Are permanent codes
3|Pa ge
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