NHA EXAM QUESTIONS AND ANSWERS 2022/2023
the difference between informed and implied consent? - Answer - Informed consent is
required in writing after explanation of a procedure, with time to ask questions, while
implied consent is assumed
What is documentation? - Answer - Documentation is a complete, accurate, up-to-date
record of the care a patient receives at a health care facility.
Disclosure refers to the way health information is: - Answer - given to an outside person
or organization.
What is the difference between consent and authorization? - Answer - **Authorization**
is permission granted by the patient or the patient's representative to release
information for reasons *other than* treatment, payment, or health care operations.
**Consent** is used only when the permission is for treatment, payment, or health care
operations.
True or False: Physicians have the option to decide whether to explain privacy rules to
their patients. - Answer - False
Auditing refers to which of the following?
(choose one)
*Writing claims
*Signing off on claims
*sending claims to third-party payers
*Reviews claims for accuracy and completeness - Answer - Reviews claims for
accuracy and completeness
True or False: Fraud is intentional misrepresentation of information for the purposes of
receiving higher payments, while abuse happens unintentionally, often because of poor
business practices. - Answer - true
define upcoding - Answer - Assigning a code that will deliberately result in a higher
payment
The Stark Law states that:
(choose one)
*debt collection agencies can't use abusive or unfair practices to collect payments.
*the government can't be charged for substandard goods or services.
,*physicians can't refer patients to practitioners with whom they have a financial
relationship.
*private health information must be kept secure. - Answer - physicians can't refer
patients to practitioners with whom they have a financial relationship.
The Office of the Inspector General is responsible for: - Answer - fighting fraud.
What is a claim? - Answer - A claim is a complete record of all the services provided to
a patient.
Identify two items of information that need to be on a claim. - Answer - Possible
answers include the patient's name, health record number, account number, and
demographic information, the subscriber number, group or plan number, and the
provider's name.
Which of the following describes a clean claim?
(choose one)
All the data elements are completed.
All the data elements are written on a white piece of paper.
Almost all the data elements are right.
All the necessary data elements are completed. - Answer - All the necessary data
elements are completed.
True or False: In 2012, the Administration Simplification Compliance Act (ASCA), part of
HIPAA, mandated that health care claims be submitted electronically, with some
exceptions. - Answer - true
The primary insurance plan does which of the following? (choose one)
Pays for everything
Pays first
Pays second
Has the option of paying first or second - Answer - Pays first
,What is an NPI number? Where does it go on CMS-1500? - Answer - the NPI is a
unique identification number for all HIPAA-covered entities, including individuals,
organizations, home health agencies, clinics, long-term care facilities, residential
treatment centers, laboratories, ambulances, group practices, and health maintenance
organizations (HMOs).
It is block 17b on the CMS-1500 form.
True or False: Misspelling a patient's name is a common processing error. - Answer -
true
Nicknames and hyphenated last names can complicate the task of getting the patient's
name correct.
True or False: You are allowed to use both six- and eight-digits for the date on one
claim. - Answer - False
You need to pick one style and use it throughout the claim.
Describe when Medicare is the secondary insurance for a patient. - Answer - Medicare
is the secondary insurance for a patient when she has a group health insurance plan, is
covered by workers' compensation, or is on disability.
By signing block 12 on the CMS-1500 form, a patient is doing which of the following?
(choose one)
Authorizing the release of funds to a provider
Authorizing the provider to perform a procedure
Authorizing the release of medical information needed to process a claim
Authorizing hospice care - Answer - Authorizing the release of medical information
needed to process a claim
Name three kinds of insurance information that needs to be collected from the patient. -
Answer - Among the correct responses are the correct policy number and group
number, if applicable; policy effective dates; and type of policy.
Coordination of benefits involves which of the following? (Choose one)
, Double-checking each patient's insurance information
Collecting demographic information
Determining which insurance is primary and which is secondary
Submitting a claim - Answer - Determining which insurance is primary and which is
secondary
The coordination of benefits process, which determines primary and secondary
insurance, ensures that there is no duplication in the payment of benefits. The primary
insurance pays first, up to its coverage limits, and the secondary insurance pays
second.
True or False: The birthday rule is a way to mark how long a patient has had his
insurance policy. - Answer - False
The birthday rule is a way to determine primary insurance if both parents have
insurance and list their children as dependents. The insurance of the parent whose
birthday is first in the calendar year is considered the primary insurance.
What is the difference between Medicare and Medicaid? - Answer - Medicare is a
government-based insurance plan that covers people older than 65, those younger than
65 with disabilities, and those with end-stage kidney disease.
Medicaid covers low-income families and individuals.
What is the advantage of employer-based self-insurance health plans? - Answer - Due
to economies of scale, employer-based self-insured health plans are more reasonably
priced than private insurance.
Which of the following accurately defines preauthorization? (choose one)
A doctor is given the go-ahead to see a patient.
A physician suggests that a patient see a specialist.
A health plan gives approval for an inpatient hospital stay or a surgical procedure.
