NHA - Certified Billing and Coding
Specialist (CBCS) Study Guide
Questions With Correct Answers
The symbol "O" in the Current Procedural Terminology reference is used to indicate
what? -ANSWER Reinstated or recycled code
In the anesthesia section of the CPT manual, what are considered qualifying
circumstances? -ANSWER Add-on codes
As of April 1, 2014 what is the maximum number of diagnoses that can be reported on
the CMS-1500 claim form before a further claim is required? -ANSWER 12
What is considered proper supportive documentation for reporting CPT and ICD codes
for surgical procedures? -ANSWER Operative report
What action should be taken first when reviewing a delinquent claim? -ANSWER Verify
the age of the account
A claim can be denied or rejected for which of the following reasons? -ANSWER Block
24D contains the diagnosis code
A coroner's autopsy is comprised of what examinations? -ANSWER Gross Examination
Medigap coverage is offered to Medicare beneficiaries by whom? -ANSWER Private
third-party payers
What part of Medicare covers prescriptions? -ANSWER Part C
What plane divides the body into left and right? -ANSWER Sagittal
Where can unlisted codes be found in the CPT manual? -ANSWER Guidelines prior to
each section
Ambulatory surgery centers, home health care, and hospice organizations use which
form to submit claims? -ANSWER UB-04 Claim Form
What color format is acceptable on the CMS-1500 claim form? -ANSWER Red
Who is responsible to pay the deductible? -ANSWER Patient
, A patient's health plan is referred to as the "payer of last resort." What is the name of
that health plan? -ANSWER Medicaid
Informed Consent -ANSWER Providers explain medical or diagnostic procedures,
surgical interventions, and the benefits and risks involved, giving patients an opportunity
to ask questions before medical intervention is provided.
Implied Consent -ANSWER A patient presents for treatment, such as extending an arm
to allow a venipuncture to be performed.
Clearinghouse -ANSWER Agency that converts claims into standardized electronic
format, looks for errors, and formats them according to HIPAA and insurance standards.
Individually Identifiable -ANSWER Documents that identify the person or provide
enough information so that the person can be identified.
De-identified Information -ANSWER Information that does not identify an individual
because unique and personal characteristics have been removed.
Consent -ANSWER A patient's permission evidenced by signature.
Authorizations -ANSWER Permission granted by the patient or the patient's
representative to release information for reasons other than treatment, payment, or
health care operations.
Reimbursement -ANSWER Payment for services rendered from a third-party payer.
Auditing -ANSWER Review of claims for accuracy and completeness.
Fraud -ANSWER Making false statements of representations of material facts to obtain
some benefit or payment for which no entitlement would otherwise exist.
Upcoding -ANSWER Assigning a diagnosis or procedure code at a higher level than the
documentation supports, such as coding bronchitis as pneumonia.
Unbundling -ANSWER Using multiple codes that describe different components of a
treatment instead of using a single code that describes all steps of the procedure.
Abuse -ANSWER Practices that directly or indirectly result in unnecessary costs to the
Medicare program.
Business Associate (BA) -ANSWER Individuals, groups, or organizations who are not
members of a covered entity's workforce that perform functions or activities on behalf of
or for a covered entity.
Specialist (CBCS) Study Guide
Questions With Correct Answers
The symbol "O" in the Current Procedural Terminology reference is used to indicate
what? -ANSWER Reinstated or recycled code
In the anesthesia section of the CPT manual, what are considered qualifying
circumstances? -ANSWER Add-on codes
As of April 1, 2014 what is the maximum number of diagnoses that can be reported on
the CMS-1500 claim form before a further claim is required? -ANSWER 12
What is considered proper supportive documentation for reporting CPT and ICD codes
for surgical procedures? -ANSWER Operative report
What action should be taken first when reviewing a delinquent claim? -ANSWER Verify
the age of the account
A claim can be denied or rejected for which of the following reasons? -ANSWER Block
24D contains the diagnosis code
A coroner's autopsy is comprised of what examinations? -ANSWER Gross Examination
Medigap coverage is offered to Medicare beneficiaries by whom? -ANSWER Private
third-party payers
What part of Medicare covers prescriptions? -ANSWER Part C
What plane divides the body into left and right? -ANSWER Sagittal
Where can unlisted codes be found in the CPT manual? -ANSWER Guidelines prior to
each section
Ambulatory surgery centers, home health care, and hospice organizations use which
form to submit claims? -ANSWER UB-04 Claim Form
What color format is acceptable on the CMS-1500 claim form? -ANSWER Red
Who is responsible to pay the deductible? -ANSWER Patient
, A patient's health plan is referred to as the "payer of last resort." What is the name of
that health plan? -ANSWER Medicaid
Informed Consent -ANSWER Providers explain medical or diagnostic procedures,
surgical interventions, and the benefits and risks involved, giving patients an opportunity
to ask questions before medical intervention is provided.
Implied Consent -ANSWER A patient presents for treatment, such as extending an arm
to allow a venipuncture to be performed.
Clearinghouse -ANSWER Agency that converts claims into standardized electronic
format, looks for errors, and formats them according to HIPAA and insurance standards.
Individually Identifiable -ANSWER Documents that identify the person or provide
enough information so that the person can be identified.
De-identified Information -ANSWER Information that does not identify an individual
because unique and personal characteristics have been removed.
Consent -ANSWER A patient's permission evidenced by signature.
Authorizations -ANSWER Permission granted by the patient or the patient's
representative to release information for reasons other than treatment, payment, or
health care operations.
Reimbursement -ANSWER Payment for services rendered from a third-party payer.
Auditing -ANSWER Review of claims for accuracy and completeness.
Fraud -ANSWER Making false statements of representations of material facts to obtain
some benefit or payment for which no entitlement would otherwise exist.
Upcoding -ANSWER Assigning a diagnosis or procedure code at a higher level than the
documentation supports, such as coding bronchitis as pneumonia.
Unbundling -ANSWER Using multiple codes that describe different components of a
treatment instead of using a single code that describes all steps of the procedure.
Abuse -ANSWER Practices that directly or indirectly result in unnecessary costs to the
Medicare program.
Business Associate (BA) -ANSWER Individuals, groups, or organizations who are not
members of a covered entity's workforce that perform functions or activities on behalf of
or for a covered entity.
