NHA CBCS CERTIFICATION
Which of the following is considered the final determination of the issues involving settlement of an
insurance claim? correct answerAdjudication
A form that contains charges, DOS, CPT codes, ICD codes, fees and copayment information is called
which of the following? correct answerEncounter form
A patient comes to the hospital for an inpatient procedure. Which of the following hospital staff
members is responsible for the initial patient interview, obtaining demographic and insurance
information, and documenting the chief complaint? correct answerAdmitting clerk
Which of the following privacy measures ensures protected health information (phi)? correct
answerUsing data encryption software on office workstations
Which of the following planes divides the body into left and right? correct answerSagittal
Which of the following provisions ensures that an insured's benefits from all insurance companies do
not exceed 100% of allowable medical expenses? correct answerCoordination of benefits
Which of the following actions should be taken first when reviewing a delinquent claim? correct
answerVerify the age of the account
Which of the following is the advantage of electronic claim submission? correct answerClaims are
expedited
Which of the following components of an explanation of benefits expedites the process of a phone
appeal? correct answerClaim control number
The standard medical abbreviation ECG refers to a test used to assess which of the following body
systems? correct answerCardiovascular system
,Which of the following actions by a billing and coding specialist would be considered fraud? correct
answerBilling for services not provided
The >< symbol is used to indicate a new and revised test other than which of the following? correct
answerProcedure descriptors
On the CMS-1500 claim form, blocks 14 through 33 contain information about which of the following?
correct answerThe patient's condition and the provider's information
Which of the following includes procedures and best practices for correct coding? correct answerCoding
Compliance Plan
When completing a CMS-1500 paper claim form, which of the following is an acceptable action for the
billing and coding specialist to take? correct answerUse arial size 10 font
A participating blue cross/blue shield (BC/BS) provider receives an explanation of benefits for a patient
account. The charged amount was $100. BC/BS allowed $80 and applied $40 to the patient's annual
deductible. BC/BS paid the balance at 80%. How much should the patient expect to pay? correct
answer$48
Which of the following indicates a claim should be submitted on paper instead of electronically? correct
answerThe claim requires an attachment
According to HIPAA standards, which of the following identifies the rendering provider on the CMS-1500
claim form in block 24j? correct answerNPI
Which of the following blocks should the billing and coding specialist complete on the CMS-1500 claim
form form for procedures, services or supplies (CPT/HCPCS)? correct answerBlock 24D
Which of the following terms describes when a plan pays 70% of the allowed amount and the patient
pays 30%? correct answerCoinsurance
, A provider charged $500 to claim that had an allowable amount of $400. In which of the following
columns should the billing and coding specialist apply the non-allowed charge? correct
answerAdjustment column of the credits
Which of the following is a HIPAA compliance guideline affecting electronic health records? correct
answerThe electronic transmission and code set standards require every provider to use the healthcare
transactions ,code sets and identifiers
Patient: Jane Austin; Social Security # 555-22-1111; Medicare ID: 555-33-2222A; DOB: 05/22/1945.
Claim information entered: Austin, Jane; Social Security #.: 555-22-1111; Medicare ID No.: 555-33-
2222A; DOB: 052245. Which of the following is a reason this claim was rejected? correct answerThe DOB
is entered incorrectly
Why does correct claim processing rely on accurately completed encounter forms? correct answerThey
streamline patient billing by summarizing the services rendered for a given date of service
A patient's health plan is referred to as the "payer of last resort." The patient is covered by which of the
following health plans? correct answerMedicaid
Which of the following color formats is acceptable on the CMS-1500 claim form? correct answerRed
Which of the following is an example of a violation of an adult patient's confidentiality? correct
answerPatient information was disclosed to the patient's parents without consent.
In the anesthesia section of the CPT manual, which of the following are considered qualifying
circumstances? correct answerAdd-on codes
Ambulatory surgery centers, home health care, and hospice organizations use the correct answerUB-04
claim form
Which of the following is a private insurance carrier? correct answerBlue Cross/ Blue Shield
Which of the following shows outstanding balances? correct answerAging report
Which of the following is considered the final determination of the issues involving settlement of an
insurance claim? correct answerAdjudication
A form that contains charges, DOS, CPT codes, ICD codes, fees and copayment information is called
which of the following? correct answerEncounter form
A patient comes to the hospital for an inpatient procedure. Which of the following hospital staff
members is responsible for the initial patient interview, obtaining demographic and insurance
information, and documenting the chief complaint? correct answerAdmitting clerk
Which of the following privacy measures ensures protected health information (phi)? correct
answerUsing data encryption software on office workstations
Which of the following planes divides the body into left and right? correct answerSagittal
Which of the following provisions ensures that an insured's benefits from all insurance companies do
not exceed 100% of allowable medical expenses? correct answerCoordination of benefits
Which of the following actions should be taken first when reviewing a delinquent claim? correct
answerVerify the age of the account
Which of the following is the advantage of electronic claim submission? correct answerClaims are
expedited
Which of the following components of an explanation of benefits expedites the process of a phone
appeal? correct answerClaim control number
The standard medical abbreviation ECG refers to a test used to assess which of the following body
systems? correct answerCardiovascular system
,Which of the following actions by a billing and coding specialist would be considered fraud? correct
answerBilling for services not provided
The >< symbol is used to indicate a new and revised test other than which of the following? correct
answerProcedure descriptors
On the CMS-1500 claim form, blocks 14 through 33 contain information about which of the following?
correct answerThe patient's condition and the provider's information
Which of the following includes procedures and best practices for correct coding? correct answerCoding
Compliance Plan
When completing a CMS-1500 paper claim form, which of the following is an acceptable action for the
billing and coding specialist to take? correct answerUse arial size 10 font
A participating blue cross/blue shield (BC/BS) provider receives an explanation of benefits for a patient
account. The charged amount was $100. BC/BS allowed $80 and applied $40 to the patient's annual
deductible. BC/BS paid the balance at 80%. How much should the patient expect to pay? correct
answer$48
Which of the following indicates a claim should be submitted on paper instead of electronically? correct
answerThe claim requires an attachment
According to HIPAA standards, which of the following identifies the rendering provider on the CMS-1500
claim form in block 24j? correct answerNPI
Which of the following blocks should the billing and coding specialist complete on the CMS-1500 claim
form form for procedures, services or supplies (CPT/HCPCS)? correct answerBlock 24D
Which of the following terms describes when a plan pays 70% of the allowed amount and the patient
pays 30%? correct answerCoinsurance
, A provider charged $500 to claim that had an allowable amount of $400. In which of the following
columns should the billing and coding specialist apply the non-allowed charge? correct
answerAdjustment column of the credits
Which of the following is a HIPAA compliance guideline affecting electronic health records? correct
answerThe electronic transmission and code set standards require every provider to use the healthcare
transactions ,code sets and identifiers
Patient: Jane Austin; Social Security # 555-22-1111; Medicare ID: 555-33-2222A; DOB: 05/22/1945.
Claim information entered: Austin, Jane; Social Security #.: 555-22-1111; Medicare ID No.: 555-33-
2222A; DOB: 052245. Which of the following is a reason this claim was rejected? correct answerThe DOB
is entered incorrectly
Why does correct claim processing rely on accurately completed encounter forms? correct answerThey
streamline patient billing by summarizing the services rendered for a given date of service
A patient's health plan is referred to as the "payer of last resort." The patient is covered by which of the
following health plans? correct answerMedicaid
Which of the following color formats is acceptable on the CMS-1500 claim form? correct answerRed
Which of the following is an example of a violation of an adult patient's confidentiality? correct
answerPatient information was disclosed to the patient's parents without consent.
In the anesthesia section of the CPT manual, which of the following are considered qualifying
circumstances? correct answerAdd-on codes
Ambulatory surgery centers, home health care, and hospice organizations use the correct answerUB-04
claim form
Which of the following is a private insurance carrier? correct answerBlue Cross/ Blue Shield
Which of the following shows outstanding balances? correct answerAging report
