NHA CBCS Exam
What actions should be taken when a claim is billed for a level four office visit and paid at a level three?
correct answerSubmit an appeal with documentation
The standard medical abbreviation "ECG" refers to a test used to assess which of the body systems?
correct answercardiovascular system- test checks electricity of heart
According to HIPAA standards, what identifies the rendering provider on the CMS-1500 claim form in
Block 24J? correct answerNPI
On the CMS-1500 claim form, blocks 14 through 33 contain information about? correct answerThe
patient's condition and the provider's information
Which block should the BCS complete on the CMS-1500 form for procedures, services, or supplies?
correct answer24D
Which term describes when a plan pays 70% of the allowed and the patient pays 30%? correct
answerCoinsurance is a percentage of the cost for covered services that is approved by the insurance
company
A provider charges $500 to a claim that had an allowable amount of $400. What should happen to the
non-allowed charge? correct answerWrite Off or adjustment
Patient: Justin Austin; Social Security NO.: 555-22-1111; Medicare ID NO.: 555-33-2222A; DOB:
05/22/1945. Claim information entered: Austin, Jane; Social Security No.: 555-22-111; Medicare ID No.:
555-33-2222A; DOB: 052245. What is a reason the claim was rejected? correct answerThe DOB is
entered incorrectly - the format is two digits for the month and four digits for the year.
A patient's health plan is referred to as the "payer of last resort." The patient is covered by which health
plan? correct answerMedicaid
, 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 the year. This amount is called what? correct
answerDeductible
Ambulatory surgery centers, home health care, and hospice organizations use what form? correct
answerUB-04 Form
A physician ordered a comprehensive metabolic panel for a 70-year-old patient who has Medicare as
her primary insurance. Which form is required so the patient knows she may be responsible for
payment? correct answerAdvanced Beneficiary Notice is a form that is required for Medicare recipients
Which of the following should the BCS complete to be reimbursed for the provider's services? correct
answerCMS-1500 claim form
What is the maximum number of diagnoses that can be reported on the CMS-1500 claim form before a
further claim is required? correct answer12
Describe a delinquent claim? correct answerIt is considered delinquent when it is overdue for payment,
120 days or older
What are considered proper supportive documentation for reporting CPT and ICD codes for surgical
procedures? correct answerOperative reports are required to support surgical procedures
When submitting a clean claim with a diagnosis of kidney stones, which of the following procedure
names is correct? correct answerNephrolithiasis The destruction of kidney stones
The BCS should first divide the e/m code by which of the following? correct answerPlace of service
which narrows down the specific code as one of the three deciding factors
Appeal the decision with a provider's report correct answerWhich of the following actions should be
taken if an insurance company denies a service as not medically necessary?
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