Exam (elaborations)
NHA CBCS 3.0 PRACTICE TEST – QUESTIONS AND ANSWERS
NHA CBCS 3.0 PRACTICE TEST – QUESTIONS AND ANSWERS
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NHA CBCS 3.0 PRACTICE TEST –QUESTIONS AND ANSWERS
A child is brought into a facility by their mother. The child is covered under
both parents' insurance policies. The child's father was born on 10/1/1980
and their mother was born on 10/2/1981. Which of the following statements
is true regarding the primary policy holder for the child? - -The father is the
primary policy holder because his birthday falls first in the calendar year.
-A billing and coding specialist is submitting a claim for a school-age child
who was brought to the clinic by their maternal grandmother. The child's
parents are divorced and remarried, and the child's mother has legal custody
of the child. The specialist should recognize that the child's primary
insurance coverage is provided through which of the following insured
individuals? - -Biologic mother
-Which of the following is the purpose of running an insurance aging report
each month? - -To determine which claims are outstanding from third-party
payers
-A billing and coding specialist observes a colleague perform an unethical
act. Which of the following actions should the specialist take? - -Report the
incident to a supervisor
-Which of the following statements is true regarding the release of patients
records? - -Patient access to psychotherapy notes is restricted
-A billing and coding specialist is preparing a claim for a patient who had a
procedure performed on their left index finger. Which of the following
modifiers indicates the correct digit? - --F1
-FA: used for left thumb
-F6: used for right index finger
-F4: used for the left pinky
-A billing and coding specialist is processing a claim for a patient who broke
their arm while repairing cars at their workplace. There is no nerve damage,
the arm is placed in a cast for 6 weeks, and the patient is cleared to return to
work in 6 weeks. Which of the following types of workers' compensation
applies to this patient? - -Temporary disability
-Based on the CPT integumentary coding guidelines, Mohs micrographic
surgery involves the provider filling which of the following roles? - -Both the
surgeon and pathologist
, -A billing and coding specialist is preparing a claim for a provider. The
operative note indicates the surgeon performed a CABG. The specialist
should identify that CABG stands for which of the following? - -Coronary
Artery Bypass Graft
-A billing and coding specialist is arranging a payment plan with a patient
who wants to leave postdated checks with the office. The patient proposes
leaving one check postdated for 3 months, one for 4 months, and another
one for 5 months in the future. According to federal collection law, which of
the following actions should the specialist take? - -Notify the patient
between 3 and 10 days prior to depositing each check on the indicated date.
-Which of the following qualifies a patient for eligibility under Medicare as
the primary third-party payer? - -Individuals who are under age 65 and have
a disability
-Which of the following is an example of a diagnostic category code? - -I10
(Diagnostic category codes contains three characters)
-A billing and coding specialist is determining third-party payer
responsibilities for a 70-year-old patient who has Medicare coverage. The
patient's spouse has insurance with Blue Cross Blue Shield through their
employer. Which of the following actions should the specialist take? - -
Establish coordination of benefits
-When a patient has a condition that is both acute and chronic, how should
it be coded? - -Code both the acute and chronic conditions, sequencing the
acute condition first.
-When reviewing an established patient's insurance card, a billing and
coding specialist notices a minor change from the existing card on file. Which
of the following actions should the specialist take? - -Photocopy both sides of
the new card
-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? - -Provider
-A provider's office receives a subpoena requesting medical documentation
from a patient's medical record. After confirming the correct authorization,
which of the following actions should a billing and coding specialist take? - -
Send the medical information pertaining to the dates of service requested.
-A billing and coding specialist is working on a claim in which reimbursement
was reduced due to services being bundled. Which of the following types of
, modifiers should be assigned to indicate multiple procedures were performed
to prevent bundling? - -Category I modifier
(category I modifier provides the means to report or indicate that a service
or procedure that has been performed has been altered by some specific
circumstance but not changed in its definition or code).
-A billing and coding specialist is reviewing an encounter note that indicates
a biopsy was performed. The specialist requires which of the following
additional details to fully code this procedure? - -Benign vs. malignant status
-A billing and coding specialist is determining the level of service for an
office visit for a new patient. Which of the following codes represents a
detailed history and detailed exam with moderate medical decision-making?
- -99204
-Which of the following is true regarding Medicaid eligibility? - -Patient
eligibility is determined at each visit.
-Which of the following pieces of guarantor information is required when
establishing a patient's financial record? - -Phone number
-A billing and coding specialist is reviewing a delinquent claim. Which of the
following actions should the specialist take first? - -Verify the age of the
account.
-When a patient signs an Acknowledgement of Notice of Privacy Practice, it
indicates which of the following? - -The patient accepts the policies and
procedures regarding how protected health information (PHI) is handled.
-Which of the following should a billing and coding specialist complete to be
reimbursed for a provider's outpatient services? - -CMS-1500 claim form
-A billing and coding specialist is preparing a claim for an appendectomy
and reports it with two units. The claim is then denied. Which of the following
coding edits should the specialist have reviewed prior to submitting the
claim? - -Medically unlikely edits (MUEs)
-A billing and coding specialist identifies a CPT code that is routinely being
denied by a third-party payer. Which of the following types of review should
the specialist perform? - -Retrospective review
-In which of the following sections of the SOAP note does a provider indicate
a patient's reported level of pain? - -Subjective
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