Exam (elaborations)

NHA CBCS CERTIFICATION EXAM STUDY GUIDE QUESTIONS AND ANSWERS UPDATED 2024

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NHA CBCS CERTIFICATION

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NHA CBCS CERTIFICATION

Which of the following is considered the final determination of the issues involving settlement of an insurance claim? -Correct Answer Adjudication A form that contains charges, DOS, CPT codes, ICD codes, fees and copayment information is called which of the following? -Correct Answer Encounter ...

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NHA CBCS CERTIFICATION EXAM

NHA CBCS CERTIFICATION EXAM STUDY
GUIDE QUESTIONS AND ANSWERS UPDATED
2024
Which of the following is considered the final determination of the issues involving
settlement of an insurance claim? -Correct Answer ✔Adjudication

A form that contains charges, DOS, CPT codes, ICD codes, fees and copayment
information is called which of the following? -Correct Answer ✔Encounter form

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? -Correct
Answer ✔Admitting clerk

Which of the following privacy measures ensures protected health information (phi)? -
Correct Answer ✔Using data encryption software on office workstations

Which of the following planes divides the body into left and right? -Correct Answer
✔Sagittal

Which of the following provisions ensures that an insured's benefits from all insurance
companies do not exceed 100% of allowable medical expenses? -Correct Answer
✔Coordination of benefits

Which of the following actions should be taken first when reviewing a delinquent claim?
-Correct Answer ✔Verify the age of the account

Which of the following is the advantage of electronic claim submission? -Correct Answer
✔Claims are expedited

Which of the following components of an explanation of benefits expedites the process
of a phone appeal? -Correct Answer ✔Claim control number

The standard medical abbreviation ECG refers to a test used to assess which of the
following body systems? -Correct Answer ✔Cardiovascular system

Which of the following actions by a billing and coding specialist would be considered
fraud? -Correct Answer ✔Billing for services not provided

The >< symbol is used to indicate a new and revised test other than which of the
following? -Correct Answer ✔Procedure descriptors

NHA CBCS CERTIFICATION EXAM

,NHA CBCS CERTIFICATION EXAM

On the CMS-1500 claim form, blocks 14 through 33 contain information about which of
the following? -Correct Answer ✔The patient's condition and the provider's information

Which of the following includes procedures and best practices for correct coding? -
Correct Answer ✔Coding Compliance Plan

When completing a CMS-1500 paper claim form, which of the following is an acceptable
action for the billing and coding specialist to take? -Correct Answer ✔Use arial size 10
font

A participating blue cross/blue shield (BC/BS) provider receives an explanation of
benefits for a patient account. The charged 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? -Correct Answer ✔$48

Which of the following indicates a claim should be submitted on paper instead of
electronically? -Correct Answer ✔The claim requires an attachment

According to HIPAA standards, which of the following identifies the rendering provider
on the CMS-1500 claim form in block 24j? -Correct Answer ✔NPI

Which of the following blocks should the billing and coding specialist complete on the
CMS-1500 claim form form for procedures, services or supplies (CPT/HCPCS)? -
Correct Answer ✔Block 24D

Which of the following terms describes when a plan pays 70% of the allowed amount
and the patient pays 30%? -Correct Answer ✔Coinsurance

A provider charged $500 to claim that had an allowable amount of $400. In which of the
following columns should the billing and coding specialist apply the non-allowed
charge? -Correct Answer ✔Adjustment column of the credits

Which of the following is a HIPAA compliance guideline affecting electronic health
records? -Correct Answer ✔The electronic transmission and code set standards require
every provider to use the healthcare transactions ,code sets and identifiers

Patient: Jane Austin; Social Security # 555-22-1111; Medicare ID: 555-33-2222A; DOB:
05/22/1945. Claim information entered: Austin, Jane; Social Security #.: 555-22-1111;
Medicare ID No.: 555-33-2222A; DOB: 052245. Which of the following is a reason this
claim was rejected? -Correct Answer ✔The DOB is entered incorrectly

Why does correct claim processing rely on accurately completed encounter forms? -
Correct Answer ✔They streamline patient billing by summarizing the services rendered
for a given date of service

NHA CBCS CERTIFICATION EXAM

, NHA CBCS CERTIFICATION EXAM

A patient's health plan is referred to as the "payer of last resort." The patient is covered
by which of the following health plans? -Correct Answer ✔Medicaid

Which of the following color formats is acceptable on the CMS-1500 claim form? -
Correct Answer ✔Red

Which of the following is an example of a violation of an adult patient's confidentiality? -
Correct Answer ✔Patient information was disclosed to the patient's parents without
consent.

In the anesthesia section of the CPT manual, which of the following are considered
qualifying circumstances? -Correct Answer ✔Add-on codes

Ambulatory surgery centers, home health care, and hospice organizations use the -
Correct Answer ✔UB-04 claim form

Which of the following is a private insurance carrier? -Correct Answer ✔Blue Cross/
Blue Shield

Which of the following shows outstanding balances? -Correct Answer ✔Aging report

Which of the following is one of the purposes of an internal auditing program in a
physician's office? -Correct Answer ✔Verifying that the medical records and the billing
record match

The star symbol in the CPT code book is used to indicate which of the following? -
Correct Answer ✔Telemedicine

Medigap coverage is offered to Medicare beneficiaries by which of the following? -
Correct Answer ✔Private third party payers

A patient's portion of the bill should be discussed with the patient before a procedure is
performed for which of the following reasons? -Correct Answer ✔To ensure the patient
understands his portion of the bill

The physician bills $500 to a patient. After submitting the claim to the insurance
company, the claim is sent back with no payment. The patient still owes $500 for this
year. This amount is called -Correct Answer ✔Deductible

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 designated 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.

NHA CBCS CERTIFICATION EXAM

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