NHA CBCS CERTIFICATION PRACTICE EXAM A|UPDATED&VERIFIED|100% SOLVED|GUARANTEED SUCCESS

Which of the following is considered the final determination of the issues involving the settlement of an insurance claim? Adjudication - is the process of putting an insurance claim through a series of edits for final determination. Chapter 4 A form that contains charges, DOS, CPT codes, fees, and copayment information is called which of the following? Encounter form is a form that contains charges, DOS, CPT code, ICD codes, fees, and copayment information. page 67 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 these duties clerk has Chapter 3 Which of the following privacy measures ensures protected health information (PHI)? Using data encryption software on office workstations - encryption software ensures that electronically transmitted health information cannot be read by third parties. This privacy measure guarantees PHI. Chapter 1 Which of the following planes divide the body into left and right? Sagittal plane divides the body into right and left sections 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 ensures that the insured benefits from all insured companies do not exceed 100% of allowable medical expenses. page 16 Which of the following actions should be taken first when reviewing a delinquent claim? Verify the age of the account is the first action. page 45 Which of the following is the advantage of electronic claim submission? Claims are expedited - submitting claims electronically is faster than submitting paper claims. page 15 Which of the following components of an explanation of benefits expedites the process of a phone appeal? Claim control number expedites the process of a phone appeal. Chapter 4 The standard medical abbreviation "ECG" refers to a test used to assess which of the following body systems? Cardiovascular system- which is a test that checks for problems with the electrical activity of the heart. Chapter 5 Which of the following actions by a billing coding specialist (bcs) would be considered fraud? Billing for a service not provided is considered fraud and can result in fines for the bcs and the physician page 6 The " " symbol is used to indicate new and revised text other than which of the following? Procedures descriptors Chapter 5 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 are found on the CMS-1500 at blocks 14 - 33 page 21 Which of the following includes procedures and best practices for correct coding? Coding Compliance Plan contains rules, procedures, and best practices to ensure accurate coding. Chapter 5 When completing a CMS-1500 paper claim form, which of the following is an acceptable action for the bcs to take? Use Arial size 10 font or OCR size 10-, or 12-point for paper claims. Chapter 2 A participating BCBS provider received an explanation of benefits for a patient account. The charge 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 page 38-39 Which of the following indicates a claim should be submitted on paper instead of electronically? The claim requires an attachment - should submit a paper form if the claim requires an attachment. Chapter 2 According to HIPAA standards, which of the following identifies the rendering provider on the CMS-1500 claim form in Block 24J? NPI Page 23 Which of the following blocks should the bcs complete on the CMS-1500 form for procedures, services, or supplies? Block 24D. Page 23 Which of the following terms describes when a plan pays 70% of the allowed and the patient pays 30%? Coinsurance is a percentage of the cost for covered services that is approved by the insurance company. Page 39 A provider charges $500 to a claim that had an allowable amount of $400. In which of the following columns should the bcs apply the non-allowed charge? The adjustment column of the credits is where adjustments are recorded. page 47