NHA CBCS EXAM REVIEW EXAM WITH QUESTIONS AND CORRECT
ANSWERS// LATEST UPDATE 2024/2025//DOWNLOAD AND PASS
Which of the following Medicare policies determines if a particular item or service
is covered by Medicare? - CORRECT ANSWER: National Coverage Determination
(NCD)
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? -
CORRECT ANSWER: Denied
A billing and coding specialist should routinely analyze which of the following to
determine the number of outstanding claims? - CORRECT ANSWER: Aging report
Which of the following should a billing and coding specialist use to submit a claim
with supporting documents? - CORRECT ANSWER: Claims attachment
Which of the following terms is used to communicate why a claim line item was
denied or paid differently than it was billing? - CORRECT ANSWER: Claim
adjustment codes
On a CMS-1500 claim form, which of the following information should the billing
and coding specialist enter into Block 32? - CORRECT ANSWER: Service facility
location information
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 the billing and coding specialist take? - CORRECT
ANSWER: Send the medical information pertaining to the dates of service
requested
,Which of the following is the deadline for Medicare claim submission? -
CORRECT ANSWER: 12 months from the date of service
Which of the following forms does a third-party payer require for physician
services? - CORRECT ANSWER: CMS-1500
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? -
CORRECT ANSWER: The billing and coding specialist sends the patient's records
to the patient's partner.
Which of the following terms refers to the difference between the billing and
allowed amounts? - CORRECT ANSWER: Adjustment
Which of the following HMO managed care services requires a referral? -
CORRECT ANSWER: Durable medical equipment
Which of the following explains why Medicare will deny a particular service or
procedure? - CORRECT ANSWER: Advance Beneficiary Notice (ABN)
Which of the following types of claims is 120 days old? - CORRECT ANSWER:
Delinquent
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? - CORRECT
ANSWER: Photocopy both sides of the new card
, 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? - CORRECT ANSWER: The wife's insurance
Which of the following would most likely result in a denial on a Medicare claim? -
CORRECT ANSWER: An experimental chemotherapy medication for a patient who
has stage III renal cancer
Which of the following pieces of guarantor information is required when
establishing a patient's financial record? - CORRECT ANSWER: Phone number
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? - CORRECT ANSWER: Pleurocentesis
A patient has AARP as secondary insurance. In which of the following blocks on
the CMS-1500 claim form should the information be entered? - CORRECT
ANSWER: Block 9
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? - CORRECT ANSWER: $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.
In the anesthesia section of the CPT manual, which of the following are considered
qualifying circumstances? - CORRECT ANSWER: Add-on codes
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