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NHA CBCS EXAM R EVIEW 2025|ACTUAL 220+ Qs&As|
LATEST UPDATE|A+GRADE
Which of the following Medicare policies determines if a particular item or service is covered by Medicare? - ANS:->> 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? ANS:->> - Denied A billing and coding specialist should routinely analyze which of the following todetermine the number of outstanding claims?
- ANS:->> Aging report Which of the following should a billing and coding specialist use to submit a claim with supporting documents? - ANS:->> 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? - ANS:->> Claim adjustment codes
On a CMS-1500 claim form, which of the following information should the billing and coding specialist enter into Block 32? ANS:->> - 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? - ANS:->> Send the medical information pertaining to the dates of service requested Which of the following is the deadline for Medicare claim submission? – ANS:->> 12 months from the date of service Which of the following forms does a third-party payer require for physician services? ANS:->> - 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? - ANS:->> The billing and coding specialist sends the patient's records to the patient's partner.
has stage III renal cancer Which of the following pieces of guarantor information is required when establishing apatient's financial record? - ANS:->> 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? ANS:->> - 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? - 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? - $ **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? - Add-on codes Threading a catheter with a balloon into a coronary artery and expanding it
to repair arteries describes which of the following procedures? - Angioplasty Which of the following actions by a billing and coding specialist would be considered fraud? - Billing for services not provided 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
for the patient to continue with coverage of care, which of the following should occur? - The provider should contact the patient's insurance carrier to obtain a new authorization Which of the following symbols indicates a revised code? - Triangle If both parents have full coverage for a dependent child, which of the following is considered to be the primary insurance holder? - The parent whose birthdate comes first in the calendar year is the primary insurance holder Which of the following entities defines the essential elements of a comprehensive compliance program? - Office of Inspector General (OIG) The >< symbol is used to indicate new and revised text other than which of the following? - Procedure descriptors Which of the following describes the organization of an aging report? - By date Which of the following is the purpose of coordination of benefits? - Prevent multiple insurers from paying benefits covered by other policies
A billing and coding specialist submitted a claim to Medicare electronically. No errors were found by the billing software or clearinghouse. Which of the following describes this claim? - Clean claim Which of the following qualifies as an exception to the HIPAA Privacy Rule? - Psychotherapy notes Which of the following would result in a claim being denied? - An italicized code used as the first listed diagnosis Which of the following standardized formats are used in the electronic filing of claims? - HIPAA standard transactions Which of the following describes a two-digit CPT code used to indicate that the provider supervised an interpreted a radiology procedure? - Professional component Which of the following formats are used to submit electronic claims to a third-party payer? - 837 Urine moved from the kidneys to the bladder through which of the following parts of the body? - Ureters
If a clean claim is received on March 1 of this year, which of the following is the allowable last day of payment in order to meet Medicare compliance requirements? - March 30 On a remittance advice form, which of the following is responsible for writing off the difference between the amount billed and the amount allowed by the agreement? - Provider Which of the following is the maximum number of modifiers that the billing and coding specialist can report on a CMS- 1500 claim form in Block 24D? - 4 When the remittance advice is sent from the third-party payer to the provider, which ofthe following actions should the billing and coding specialist perform first? - Ensure proper payment has been made Which of the following is a reason a claim would be denied? - Incorrectly linked codes The billing and coding specialist should follow the guidelines in the CPT manual for which of the following reasons? - The guidelines define items
that are necessary toaccurately code Which of the following documentation is a valid authorization to release medical information to the judicial system? - Subpoena duces tecum A claim is denied due to termination of coverage. Which of the following actions should the billing and coding specialist take next? - Follow up with the patient to determine current name, address, and insurance carrier for resubmission A patient who has a primary malignant neoplasm of the lung should be referred to which of the following specialists? - Pulmonary oncologist Which of the following is a HIPAA compliance guideline affecting electronic health records? - The electronic transmission and code set standards require every provider to use the healthcare transactions, code sets, and identifiers Which of the following options is considered proper supportive documentation for reporting CPT and ICD codes for surgical procedures? - Operative report Which of the following blocks on the CMS-1500 claim form is used to
Which of the following forms should the billing and coding specialist transmit to the insurance carrier for reimbursement of inpatient hospital services? - UB- 04 A patient has laboratory work done in the emergency department after an inhalation of toxic fumes from a faulty exhaust fan at her place of employment. Which of the following is responsible for that charges? - Worker's compensation A billing and coding specialist is preparing a claim form for a provider from a group practice. The billing and coding specialist should enter the rendering provider's national provider identifier (NPI) into which of the following blocks on the CMS- 1500 claim form?
- Block 24J Which of the following is included in the release of patient information? - The date ofthe last disclosure Which of the following describes a key component of an evaluation and management service? - History Which of the following reports is used to arrange the accounts receivable from
the date of service? - Aging report Which of the following best describes medical ethics? - Medical standard of conduct A provider performs an examination of a patient's knee joint via small incisions and an optical device. Which of the following terms describes this procedure? - Arthrosco py Which of the following accurately describes code symbols found in the CPT manual? - A product pending FDA approval is indicated as a lightning-bolt symbol On the CMS- 1500 claim form, blocks 14 through 33 contain information about which ofthe following? - The patient's condition and the provider's information Which of the following describes an insurance carrier that pays the provider whorendered services to a patient? - Third-party payer In 1996, CMS implemented which of the following to detect inappropriate and
additionalclaim for the secondary payer and send it with a copy of which of the following? - Remittance advice Which of the following actions by the billing and coding specialist prevents fraud? - Performing periodic audits When doing a front torso burn, which of the following percentages should be coded? - 18% Which of the following blocks should the billing and coding specialist complete on the CMS- 1500 claim form for procedures, services, or supplies? - Block 24D Which of the following blocks of the CMS-1500 claim form indicates an ICD diagnosis code? - Block 21 Which of the following national provider identifiers (NPIs) is required in Block 33a of aCMS- 1500 claim form? - Billing provider Which of the following causes a claim to be suspended? - Services require additionalinformation
Which of the following terms is used to describe the location of the stomach, the spleen, part of the pancreas, part of the liver, and part of the small and large intestines? - Left upper quadrant Which of the following terms is used to describe the location of the right lobe of the liver, the gallbladder, part of the pancreas, and part of the small and large intestine? - Right upper quadrant Which of the following terms is used to describe the location of the small and large intestine, the appendix, and the right ureter? - Right lower quadrant Which of the following terms is used to describe the location of the small and large intestines and the left ureter? - Left lower qaudrant
Which of the following organizations fights waste, fraud, and abuse in Medicare and Medicaid? - Office of Inspector General (OIG) Which of the following is used to code diseases, injuries, impairments, and other health- related problems? - International Classification of Diseases (ICD) Actions should be taken if an insurance company denies a service as not medicallynecessary? - Appeal the decision with a provider's report The actions should be taken when a claim is billed for a level four office visit and paid at a level three? - Submit an appeal to the carrier with the supporting documentation All dependents 10 years of age or older are required to have a military identification card for TRICARE? - Military identification All e-mail correspondence to a third-party payer containing patient's protected health information (PHI) should be? - Encrypted Ambulatory surgery center, home health care, and hospice organizations use the? - UB- 04 claim form
A billing and coding specialist should understand that the financial record source that is generated by a provider's office is called a? - Patient Ledger Account What component of an explanation of benefits expedites the process of a phone appeal? - Claim control number A coroner's autopsy is comprised of which examination? - Gross examination What do physician's used to electronically submit claims? - Clearinghouse A form that contains charges, DOS, CPT codes, ICD- 10 - CM, fees, and copayment information is a? - Encounter form The function of the respiratory system? - Oxygenating blood cells What medical term refers to the sac that enclosed the heart? - Pericardium Medigap coverage is offered to Medicare beneficiaries by? - Private third-party payers
