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NHA CBCS Exam Study Guide Questions and Answers | Verified Answers 2022/2023
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NHA CBCS Exam Study Guide Questions and Answers | Verified Answers 2022/2023
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NHA CBCS Exam Study Guide 2022/20231.Medical Billing & Coding as a Career: *Claims assistant professional or
claims manager, *Coding Specialist, * Collection Manager, *Electronic
Claims Proces- sor, *Insurance Billing Specialist, * Insurance
Coordinator, *Insurance Counselor,
*Medical Biller, *Medical & Financial Records Manager, * Billing &
Coding Special- ist
2. What are Medical Ethics?: 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.
3. What does acting within ethical behavior boundaries mean?: carrying
out one's responsibilities w/ integrity, dignity, respect, honesty,
competence, fairness, & trust.
4. Legal Aspects of of Medical Billing & Coding:: ...
5. Compliance regulations:: Most billing-related cases are based on
HIPPA and False Claims Act
6. Health Insurance Portability & Accountability Act (HIPPA): 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
,7. What are the 2 provisions of HIPPA?: Title I: Insurance
Reform Title II: Administrative Simplification
8. What is Title I of HIPPA?: Insurance Reform-primary purpose is to
provide con- tinuous 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.
9. What is Title II of HIPPA?: 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
10.What is the False Claims Act (FCA)?: 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.
11.What is the National Correct Coding Initiative (NCCI)?: 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.
, 12.How many edits does NCCI include?: 2: 1)Column 1/Column 2 (prev
called Comprehensive/Component) Edits
2) Mutually Exclusive Edits
13.Column 1/Column 2 edits (NCCI): Identifies code pairs that should not
be billed together b/c 1 code (Column 1) includes all the services
described by another code (Column 2)
14.Mutually Exclusive Edits (NCCI): ID's code pairs that, for clinical
reasons, are unlikely to be performed on the same pt on the same day
15.What are the possible consequences of inaccurate coding and
incorrect billing?: *delayed processing & payment of claims *reduced
payments, denied claims *fine and/or imprisonment *exclusion from
payer's programs, loss of dr's license to practice med
16.Who has the task of investigate and prosecuting health care fraud
& abuse?: The Office of Inspector General (OIG)
17.Fraud: knowingly & intentionally deceiving or misrepresenting info
that may result in unauthorized benefits. It is a felony and can result
in fines and/or prison.
18.Who audits claims?: State & federal agencies as well as private ins
co's
19.What are common forms of fraud?: billing for services not
furnished, un- bundling, & misrepresenting diagnosis to justify
payment
20.Abuse: incidences or practices, not usually considered fraudulent,
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