NHA CBCS Certification Exam 2024 Version Best
Studying Material with All Questions from Actual
Exam and Correct Answer
When coding on the UB-04 form, the billing and coding specialist must sequence the diagnosis
codes according to the ICD guidelines. Which of the following is the first listed diagnosis code?
----------- Correct Answer ------------ Principal diagnosis
Which of the following was developed to reduce Medicare program expenditures by detecting
inappropriate codes and eliminating improper coding practices? ----------- Correct Answer --------
---- NCCI
What are Category II CPT Codes? ---------- Correct Answer ---------- Supplemental tracking
codes - used for performance measurement
What is coinsurance? ---------- Correct Answer ---------- Percentage of costs the insurance
company and insured each pay (usually 80/20)
What are the three key components of an E/M code? ----------- Correct Answer ---------- History,
examination, and medical decision making
What is a pre-existing condition? ----------- Correct Answer ---------- An illness or condition
present before insurance coverage begins
A new patient is: ----------- Correct Answer ---------- One who has not visited the physician in
more than 3 years
What does block 33 on the CMS-1500 claim form indicate? ---------- Correct Answer ----------
The billing information (either the servicing provider's info or a 3rd party billing company)
What is an authorization? ---------- Correct Answer ---------- Permission granted by the patient or
patient's representative to release information for reason other than treatment, payment, or health
care operations
Which of the following organizations identifies improper payments made on CMS claims? -------
---- Correct Answer ------------ Recovery Audit Contractors
Which of the following describes the status of a claim that does not include required
preauthorization for a service? ----------- Correct Answer ------------ Denied
Which of the following actions by the billing and coding specialists prevents fraud? -----------
Correct Answer ------------ Performing periodic audits
Which of the following does a patient sign to allow payment of claims directly to the provider? --
,--------- Correct Answer ------------ Assignment of benefits
Which of the following actions should the billing and coding specialist take if he observes a
colleague in an unethical situation? ----------- Correct Answer ------------ Report the incident to a
supervisor
Which of the following is the purpose of precertification? ----------- Correct Answer ------------
Verification of coverage
A provider performs an examination of a patient's throat during an office visit. Which of the
following describes the level of the examination? ----------- Correct Answer ------------ Problem
focused examination
Which of the following is the verbal or written agreement that gives approval to some action,
situation, or statement, and allows the release of patient information? ----------- Correct Answer -
----------- Constant agreement
A claim can be denied or rejected for which of the following reasons? ----------- Correct Answer
------------ Block 24D contains the diagnosis code
On the CMS-1500 claim form, Blocks 1 through 13 include which of the following? -----------
Correct Answer ------------ The patient demographics
To be compliant with HIPAA, which of the following positions should be assigned in each
office? ----------- Correct Answer ------------ Privacy officer
Which of the following information should the billing and coding specialist input into Block 33a
on the CMS-1500 claim form? ----------- Correct Answer ------------ National provider
identification number
Which part of Medicare covers prescriptions? ----------- Correct Answer ------------ Part D
Which of the following is the function of the respiratory system? ----------- Correct Answer ------
------ Oxygenating blood cells
Urine moves from the kidneys to the bladder through which of the following parts of the body? -
---------- Correct Answer ------------ Ureters
Claims that are submitted without an NPI number will delay payment to the provider because ----
------- Correct Answer ------------ The number is needed to identify the provider
Which of the following sections of the medical record is used to determine the correct Evaluation
and Management code used for billing and coding? ----------- Correct Answer ------------ History
and physical
On a remittance advice form, which of the following is responsible for writing off the difference
,between the amount billed and the amount allowed by the agreement? ----------- Correct Answer
------------ Provider
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? ----------- Correct Answer ------------ The
parent whose birthdate comes first in the calendar year
Which of the following statements is correct regarding a deductible? ----------- Correct Answer --
---------- The deductible is the patient's responsibility
Which of the following claims is submitted and then optically scanned by the insurance carrier
and converted to an electronic form? ----------- Correct Answer ------------ Paper claim
A patient who has a primary malignant neoplasm of the lung should be referred to which of the
following specialists? ----------- Correct Answer ------------ Pulmonary oncologist
Which of the following statements is true regarding the release of patient records? -----------
Correct Answer ------------ Patient access to psychotherapy notes may be restricted
Which of the following is the primary function of the heart? ----------- Correct Answer ------------
Pumping blood in the circulatory system
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? -----------
Correct Answer ------------ Fraud
A patient has AARP as secondary insurance. In which of the following blocks on the CMS-1500
claim form should this information be entered? ----------- Correct Answer ------------ Block 9
A patient with a past due balance requests that his records be sent to another provider. Which of
the following actions should be taken? ----------- Correct Answer ------------ Accommodate the
request and send the records
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? ----------- Correct Answer ------------ Invalid
Which of the following medical terms refers to the sac that encloses the heart? ----------- Correct
Answer ------------ Pericardium
A physician is contracted with an insurance company to accept the allowed amount. The
insurance company allows $80 of a $120 billed amount, and $50 of the deductible has been met.
How much should the physician write off the patient's account? ----------- Correct Answer --------
---- $40
, 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? ----------- Correct
Answer ------------ The provider receives payment directly form the payer
Which of the following describes the content of a medical practice aging report? -----------
Correct Answer ------------ an overview of the practices outstanding claims
When a physician documents a patient's response to symptoms and various body systems, the
results are documented as which of the following? ----------- Correct Answer ------------ Review
of systems
Medicare enforces mandatory submission of electronic claims for most providers. Which of the
following providers is allowed to submit paper claims to medicare? ----------- Correct Answer ---
--------- A provider's office with fewer than 10 full time employees
Which of the following is the correct term for an amount that has been determined to be
uncollectible? ----------- Correct Answer ------------ Bad debt
Which of the following actions should the billing and coding specialist take to effectively
manage accounts receivable? ----------- Correct Answer ------------ Collect copayment from the
patient at the time of service
If a patient has osteomyelitis. he has problems with which of the following areas? -----------
Correct Answer ------------ Bones and bone marrow
Which of the following is used by providers to remove errors from claims before the are
submitted to third-party payers? ----------- Correct Answer ------------ Clearinghouse
A provider receives a reimbursement from a third-party payer accompanied by which of the
following documents? ----------- Correct Answer ------------ Explanation of Benefits
Which of the following is the appropriate diagnosis for a patient who has an abnormal
accumulation of fluid in her lower leg that has resulted in swelling? ----------- Correct Answer ---
--------- Edema
Which of the following blocks on the CMS-1500 claim form is used to bill ICD codes? -----------
Correct Answer ------------ Block 21
Patient charges that have not been paid will appear in which of the following? ----------- Correct
Answer ------------ Accounts receivable
When billing a secondary insurance company, which block should the billing & coding specialist
fill out on the CMS-1500 claim form? ----------- Correct Answer ------------ 9a
Which of the following forms must the patient or representative sign to allow for the release of
protected health information? ----------- Correct Answer ------------ Authorization
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