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NHA CBCS EXAM REVIEW Questions and Answers | Verified Answers 2022/2023
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NHA CBCS EXAM REVIEW Questions and Answers 2022/20231. Which of the following Medicare policies determines if a particular item
or service is covered by Medicare?: Answer- National Coverage
Determination (NCD)
2. A patient's employer has not submitted a premium payment. Which of
the following claim statuses should the provider receive from the third-
party payer?: Answer- Denied
3. A billing and coding specialist should routinely analyze which of the
following to determine the number of outstanding claims?: Answer-
Aging report
4. Which of the following should a billing and coding specialist use to
submit a claim with supporting documents?: Answer- Claims attachment
5. Which of the following terms is used to communicate why a claim line
item was denied or paid differently than it was billing?: Answer- Claim
adjustment codes
6. On a CMS-1500 claim form, which of the following information should
the billing and coding specialist enter into Block 32?: Answer- Service
facility location information
7. A provider's office receives a subpoena requesting medical documenta-
tion from a patient's medical record. After confirming the correct
authoriza- tion, which of the following actions should the billing and
,coding specialist take?: Send the medical information pertaining to the
dates of service requested
8. Which of the following is the deadline for Medicare claim submission?:
12 months from the date of service
9. Which of the following forms does a third-party payer require for
physician services?: CMS-1500
10.A patient who is an active member of the military recently returned from
overseas and is in need of specialty care. The patient does not have
anyone designed with power of attorney. Which of the following is
considered a HIPAA violation?: The billing and coding specialist sends
the patient's records to the patient's partner.
11.Which of the following terms refers to the difference between the
billing and allowed amounts?: Adjustment
12. Which of the following HMO managed care services requires a
referral?-
: Durable medical equipment
13.Which of the following explains why Medicare will deny a
particular service or procedure?: Advance Beneficiary Notice (ABN)
14.Which of the following types of claims is 120 days old?: Delinquent
,15.When reviewing an established patient's insurance card, the billing
and coding specialist notices a minor change from the existing card on
file. Which of the following actions should the billing and coding
specialist take?: Photocopy both sides of the new card
16.A husband and wife each have group insurance through their
employers. The wife has an appointment with her provider. Which
insurance should be used as primary for the appointment?: The wife's
insurance
17.Which of the following would most likely result in a denial on a
Medicare claim?: An experimental chemotherapy medication for a
patient who has stage III renal cancer
18.Which of the following pieces of guarantor information is required
when establishing a patient's financial record?: Phone number
19.A provider surgically punctures through the space between the
patient's ribs using an aspirating needle to withdraw fluid from the chest
cavity. Which of the following is the name of this procedure?:
Pleurocentesis
20.A patient has AARP as secondary insurance. In which of the
following blocks on the CMS-1500 claim form should the information be
entered?: - Block 9
21.A Medicare non-participating (non-PAR) provider's approved payment
amount is $200 for a lobectomy and the deductible has been met. Which
of the following amounts is the limiting charge for this procedure?: $230
**A non-PAR who does not accept assignment, can collect a maximum
, of 15% (the limiting charge) over the non-PAR Medicare fee schedule
amount.
22.In the anesthesia section of the CPT manual, which of the following
are considered qualifying circumstances?: Add-on codes
23.Threading a catheter with a balloon into a coronary artery and
expanding it to repair arteries describes which of the following
procedures?: Angioplasty
24.Which of the following actions by a billing and coding specialist
would be considered fraud?: Billing for services not provided
25.Which of the following statements is accurate regarding the
diagnostic codes in Block 21?: These codes must correspond to the
diagnosis pointer in Block 24E
26.Which of the following parts of the Medicare insurance program is man-
aged by private, third-party insurance providers that have been approved
by Medicare?: Medicare Part C
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