NHA MEDICAL BILLING AND CODING 2024/25 EXAM REVIEW QUESTIONS AND ANSWERS, VERIFIED/[LATEST EXAM UPDATES]
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NHA MEDICAL BILLING AND CODING 2024/25 EXAM
REVIEW QUESTIONS AND ANSWERS, VERIFIED/
Which of the following describes the reason for a claim rejection because of Medicare NCCI edits? -
-Improper Code Combinations
(Medicare NCCI edits will trigger a claim rejection for improper code combinations...
1 NHA MEDICAL BILLING AND CODING 2024/25 EXAM
REVIEW QUESTIONS AND ANSWERS, VERIFIED/
Which of the following describes the reason for a claim rejection because of Medicare NCCI edits? -
✅✅-Improper Code Combinations
(Medicare NCCI edits will trigger a claim rejection for improper code combinations)
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
(Invalid claim contains illogical or incorrect information and is returned to the provider unprocessed)
Medigap coverage is offered to Medicare beneficiaries by which of the following - ✅✅-Private Third-
Party Payers
(Private third-party payers offer supplement coverage to Medicare beneficiaries who pay their Medicare
premium.)
Which of the following provisions ensures that an insured's benefits from all insurance companies do
not exceed 100% of allowable medical expenses? - ✅✅-Coordination of benefits
(Coordination of benefits ensures that the insured benefits from all insured companies do not exceed
100% of allowable medical expenses)
A coroner's autopsy is comprised of which of the - ✅✅-Gross Examination
(Gross examination is an integral part of an autopsy.)
,Which of the following statements is true regarding the release of patient records?
A. Verbal requests for records from life insurance companies are appropriate.
B. Identification is not required when requesting access to patient records.
C. Providers cannot share a patient's medical information with other health care professionals if the
patient is mentally unstable.
D. Patient access to psychotherapy notes may be restricted - ✅✅-Patient access to psychotherapy
notes may be restricted
(Patients cannot access psychotherapy notes or information compiled for lawsuits.)
Which of the following actions by a billing and coding specialist would be considered fraud?
A. Submitting a claim for services that are not medically necessary
B. Violating participating provider agreements with third-party payers
C. Billing for services not provided
D. Billing non-covered services as covered services - ✅✅-Billing for services not provided
(Billing for services not provided is considered fraud and can result in fines for the billing and coding
specialist and the physician.)
Which of the following components of an explanation of benefits expedites the process of a phone
appeal?
A. NPI number
B. Claim control number
C. Insured's ID number
D. Check number - ✅✅-B. Claim control number
(The claim control number expedites the process of a phone appeal.)
,On the CMS-1500 claim form, blocks 14 through 33 contain information about which of the following? -
✅✅-The patient's condition and the provider's information
(The patient's condition and the provider's information are found on the CMS-1500 at blocks 14 through
33.)
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 patient ledger account is a history of the patient's financial record.)
Which of the following medical terms refers to the sac that encloses the heart? - ✅✅-Pericardium
(Peri- means "around" and -cardium means "pertaining to heart.")
HIPPA transaction standards apply to which of the following entities?
A. Employers who provide workers' compensation plans
B. Automobile insurance agencies
C. Health care clearinghouses
D. Educational facilities - ✅✅-Health care clearinghouses
(Entities covered by HIPAA regulations include health care clearinghouses, providers of health care
services, and health care third-party payers who submit transactions electronically.)
All dependents 10 yrs of age are required to have which of the following for TRICARE?
A. Signature on file
B. Military identification
, C. Assignment of benefits
D. Provider signature - ✅✅-Military identification
(Military identification cards pertain to retirees, active duty sponsors, and their eligible family members
as a means of identification for TRICARE.
The standard medical abbreviation "ECG" refers to a test used to assess which of the following body
systems? - ✅✅-Cardiovascular system
(An electrocardiogram is a test that checks for problems with the electrical activity of the heart.)
Which of the following is an example of a violation of an adult patient's confidentiality?
A. While reviewing a claim, the billing and coding specialist reads the diagnosis before realizing that the
patient is a neighbor.
B. A billing and coding specialist queries the physician about a diagnosis in a patient's medical record.
C. The physician uses his home phone to discuss patient care with the nursing staff.
D.Patient information was disclosed to the patient's parent without consent. - ✅✅-Patient information
was disclosed to the patient's parent without consent.
(Disclosing information to anyone without the patient's consent is a violation of patient confidentiality.)
Claims that are submitted without an NPI number will delay payment to the provider because - ✅✅-the
number is needed to identify the provider.
(An NPI number is provided by the Centers for Medicare and Medicaid Services to all providers.)
Which section of the medical record is used to determine the correct Evaluation and Management code
used for billing and coding? - ✅✅-History and physical
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