NHA CBCS CERTIFICATION EXAM/21
QUESTONS AND ANSWERS
Which of the following is considered the final determination of the issues
involving settlement of an insurance claim? - -Adjudication
-A form that contains charges, DOS, CPT codes, ICD codes, fees and
copayment information is called which of the following? - -Encounter 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? - -Admitting clerk
-Which of the following privacy measures ensures protected health
information (phi)? - -Using data encryption software on office workstations
-Which of the following planes divides the body into left and right? - -
Sagittal
-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
-Which of the following actions should be taken first when reviewing a
delinquent claim? - -Verify the age of the account
-Which of the following is the advantage of electronic claim submission? - -
Claims are expedited
-Which of the following components of an explanation of benefits expedites
the process of a phone appeal? - -Claim control number
-The standard medical abbreviation ECG refers to a test used to assess
which of the following body systems? - -Cardiovascular system
-Which of the following actions by a billing and coding specialist would be
considered fraud? - -Billing for services not provided
-The >< symbol is used to indicate a new and revised test other than which
of the following? - -Procedure descriptors
, -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
-Which of the following includes procedures and best practices for correct
coding? - -Coding 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? - -Use 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? - -$48
-Which of the following indicates a claim should be submitted on paper
instead of electronically? - -The 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? - -NPI
-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)? - -Block 24D
-Which of the following terms describes when a plan pays 70% of the
allowed amount and the patient pays 30%? - -Coinsurance
-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? - -Adjustment column of the credits
-Which of the following is a HIPAA compliance guideline affecting electronic
health records? - -The 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? - -The DOB is
entered incorrectly
, -Why does correct claim processing rely on accurately completed encounter
forms? - -They 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? - -Medicaid
-Which of the following color formats is acceptable on the CMS-1500 claim
form? - -Red
-Which of the following is an example of a violation of an adult patient's
confidentiality? - -Patient 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? - -Add-on codes
-Ambulatory surgery centers, home health care, and hospice organizations
use the - -UB-04 claim form
-Which of the following is a private insurance carrier? - -Blue Cross/ Blue
Shield
-Which of the following shows outstanding balances? - -Aging report
-Which of the following is one of the purposes of an internal auditing
program in a physician's office? - -Verifying that the medical records and the
billing record match
-The star symbol in the CPT code book is used to indicate which of the
following? - -Telemedicine
-Medigap coverage is offered to Medicare beneficiaries by which of the
following? - -Private third party payers
-A patient's portion of the bill should be discussed with the patient before a
procedure is performed for which of the following reasons? - -To ensure the
patient understands his portion of the bill
-The physician bills $500 to a patient. After submitting the claim to the
insurance company, the claim is sent back with no payment. The patient still
owes $500 for this year. This amount is called - -Deductible
-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
designated with power of attorney. Which of the following is considered a
QUESTONS AND ANSWERS
Which of the following is considered the final determination of the issues
involving settlement of an insurance claim? - -Adjudication
-A form that contains charges, DOS, CPT codes, ICD codes, fees and
copayment information is called which of the following? - -Encounter 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? - -Admitting clerk
-Which of the following privacy measures ensures protected health
information (phi)? - -Using data encryption software on office workstations
-Which of the following planes divides the body into left and right? - -
Sagittal
-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
-Which of the following actions should be taken first when reviewing a
delinquent claim? - -Verify the age of the account
-Which of the following is the advantage of electronic claim submission? - -
Claims are expedited
-Which of the following components of an explanation of benefits expedites
the process of a phone appeal? - -Claim control number
-The standard medical abbreviation ECG refers to a test used to assess
which of the following body systems? - -Cardiovascular system
-Which of the following actions by a billing and coding specialist would be
considered fraud? - -Billing for services not provided
-The >< symbol is used to indicate a new and revised test other than which
of the following? - -Procedure descriptors
, -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
-Which of the following includes procedures and best practices for correct
coding? - -Coding 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? - -Use 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? - -$48
-Which of the following indicates a claim should be submitted on paper
instead of electronically? - -The 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? - -NPI
-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)? - -Block 24D
-Which of the following terms describes when a plan pays 70% of the
allowed amount and the patient pays 30%? - -Coinsurance
-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? - -Adjustment column of the credits
-Which of the following is a HIPAA compliance guideline affecting electronic
health records? - -The 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? - -The DOB is
entered incorrectly
, -Why does correct claim processing rely on accurately completed encounter
forms? - -They 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? - -Medicaid
-Which of the following color formats is acceptable on the CMS-1500 claim
form? - -Red
-Which of the following is an example of a violation of an adult patient's
confidentiality? - -Patient 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? - -Add-on codes
-Ambulatory surgery centers, home health care, and hospice organizations
use the - -UB-04 claim form
-Which of the following is a private insurance carrier? - -Blue Cross/ Blue
Shield
-Which of the following shows outstanding balances? - -Aging report
-Which of the following is one of the purposes of an internal auditing
program in a physician's office? - -Verifying that the medical records and the
billing record match
-The star symbol in the CPT code book is used to indicate which of the
following? - -Telemedicine
-Medigap coverage is offered to Medicare beneficiaries by which of the
following? - -Private third party payers
-A patient's portion of the bill should be discussed with the patient before a
procedure is performed for which of the following reasons? - -To ensure the
patient understands his portion of the bill
-The physician bills $500 to a patient. After submitting the claim to the
insurance company, the claim is sent back with no payment. The patient still
owes $500 for this year. This amount is called - -Deductible
-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
designated with power of attorney. Which of the following is considered a
