NHA CBCS certification final exam with 100% correct answers 2024

NHA CBCS certification final exam with 100% correct answers 2024. A beneficiary of a medicare/medicaid crossover claim submitted by a participating provider is responsible for which of the following percentages? - 0% A biller will electronically submit a claim to the carrier via which of the following? - Direct data entry A billing and coding specialist is review a CMS-1500 claim form. The assignment of the benefits box has been checked yes. The check box indicates which of the following? - The provider receives payment directly form the payer A billing and coding specialist needs to know how much Medicare paid on a claim before billing the secondary insurance. To which of the following should the specialist refer to? - Remittance advice A billing and coding specialist should add modifier -50 to codes when reporting which of the following? - Bilateral procedure A billing and coding specialist should enter the prior authorization number on the CMS-1500 claim form in the following block? - Block 23 A billing and coding specialist should understand that the financial record source that is generated by a provider's office is called a - patient ledger account A claim can be denied or rejected for which of the following reasons? - Block 24D contains the diagnosis code A claim is denied because the service was not covered by the insurance company. Upon confirmation of no errors on the claim, which of the following describes the process that will follow the denial? - The claim will not be resubmitted and the patient will be sent a bill A claim is denied due to termination of coverage. Which of the following actions should the billing and coding specialist take next? - Follow up with the patient to determine name, address and insurance carrier for resubmission A claim is submitted with a transposed insurance member ID number and returned to the provider, which of the following describes the status that should be assigned to the claim by the carrier? - Invalid A coroner's autopsy is comprised of which of the following examinations? - Gross examination A deductible of $100 is applied to a patient's remittance advice. The provider requests the account personnel write it off. Which of the following terms describes this scenario? - Fraud A dependent child whose parents both have insurance coverage comes to the clinic. The billing and coding specialist uses the birthday rule to determine which insurance policy is primary. Which of the following describes the birthday rule? - The parent whose birthdate comes first in the calendar year A form that contains charges, DOS, CPT codes, ICD codes, fees and copayment information is called which of the following? - Encounter form A in soap is - Assessment A nurse is reviewing a patient's lab results prior to discharge and discovers an elevated glucose level. Which of the following health care providers should be altered before the nurse can proceed with discharge planning? - The attending physician 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? - $48 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? - Admitting clerk A patient has AARP as secondary insurance. In which of the following blocks on the CMS-1500 claim form should this information be entered? - Block 9 A patient has an emergency appendectomy while on vacation. The claim is rejected due to the patient obtaining services out-of-network. Which of the following information should be included on the claim appeal? - The patient was out of town during the emergency A patient has met a medicare deductible of $150. The patient's coinsurance is 20% and the allowed amount is $600. Which of the following is the patient's out of pocket expense? - $120 A patient is upset about a bill she received. Her insurance company denied the claim. Which of the following actions is an appropriate way to handle the situation? - Inform the patient of the reason of the denial A patient presents to the provider with chest pain and SOB. After an unexpected ECG result, the provider calls a cardiologist and summarizes the patient's symptoms. What portion of HIPAA allows the provider to speak to the cardiologist prior to obtaining the patient's consent? - TITLE II A patient who has a HMO insurance plan needs to see a specialist for a specific problem. From which of the following should the patient obtain a referral? - Primary care provider