NHA CBCS EXAM REVIEW 2023 Questions and answers with A+ Guarantee)

1. Which of the following Medicare policies determines if a particular item or service is covered by Medicare?: National Coverage Determination (NCD) 2. A patient's employer has not submitted a premium payment. Which of the following claim statuses should the provider receive from the third-party payer?: Denied 3. A billing and coding specialist should routinely analyze which of the following to determine the number of outstanding claims?: Aging report 4. Which of the following should a billing and coding specialist use to submit a claim with supporting documents?: Claims attachment 5. Which of the following terms is used to communicate why a claim line item was denied or paid differently than it was billing?: Claim adjustment codes 6. On a CMS-1500 claim form, which of the following information should the billing and coding specialist enter into Block 32?: Service facility location information 7. A provider's office receives a subpoena requesting medical documenta- tion from a patient's medical record. After confirming the correct authoriza- tion, which of the following actions should the billing and coding specialist take?: Send the medical information pertaining to the dates of service requested 8. Which of the following is the deadline for Medicare claim submission?: 12 months from the date of service 9. Which of the following forms does a third-party payer require for physician services?: CMS-1500 10. 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 designed with power of attorney. Which of the following is considered a HIPAA violation?: The billing and coding specialist sends the patient's records to the patient's partner. 11. Which of the following terms refers to the difference between the billing and allowed amounts?: Adjustment 12. Which of the following HMO managed care services requires a referral?- : Durable medical equipment 13. Which of the following explains why Medicare will deny a particular service or procedure?: Advance Beneficiary Notice (ABN) 14. Which of the following types of claims is 120 days old?: Delinquent 15. When reviewing an established patient's insurance card, the billing and coding specialist notices a minor change from the existing card on file. Which of the following actions should the billing and coding specialist take?: Photocopy both sides of the new card 16. A husband and wife each have group insurance through their employers. The wife has an appointment with her provider. Which insurance should be used as primary for the appointment?: The wife's insurance 17. Which of the following would most likely result in a denial on a Medicare claim?: An experimental chemotherapy medication for a patient who has stage III renal cancer 18. Which of the following pieces of guarantor information is required when establishing a patient's financial record?: Phone number 19. A provider surgically punctures through the space between the patient's ribs using an aspirating needle to withdraw fluid from the chest cavity. Which of the following is the name of this procedure?: Pleurocentesis 20. A patient has AARP as secondary insurance. In which of the following blocks on the CMS-1500 claim form should the information be entered?: - Block 9 21. A Medicare non-participating (non-PAR) provider's approved payment amount is $200 for a lobectomy and the deductible has been met. Which of the following amounts is the limiting charge for this procedure?: $230 **A non-PAR who does not accept assignment, can collect a maximum of 15% (the limiting charge) over the non-PAR Medicare fee schedule amount. 22. In the anesthesia section of the CPT manual, which of the following are considered qualifying circumstances?: Add-on codes 23. Threading a catheter with a balloon into a coronary artery and expanding it to repair arteries describes which of the following procedures?: Angioplasty 24. Which of the following actions by a billing and coding specialist would be considered fraud?: Billing for services not provided 25. Which of the following statements is accurate regarding the diagnostic codes in Block 21?: These codes must correspond to the diagnosis pointer in Block 24E 26. Which of the following parts of the Medicare insurance program is man- aged by private, third-party insurance providers that have been approved by Medicare?: Medicare Part C