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NHA CBCS EXAM VERSION 3
Consist of 120 multichoice Questions with Answers
- A specialist is submitting a batch of claims to the clearinghouse and re- ceived a report stating three claims were rejected. What should the specialists next steps be? A. Build a patient for service is not covered B. Reviews of scrubber report C. Call the third-party payer to determine the reason for rejection D. Appeal the rejection Answer Review the scrubber report
- Which of the following actions should be taken by a specialist to ensure a patient's health information is protected? A. Confirming test results with the patient over the phone at the reception area. B. Asking the patients reason for their visit during check-in. C. Using data encryption software on office workstation. D. Leaving the workstation unlocked while stepping away to assist another patient.
Answer Using data encryption software on office workstations
- Which of the following is an advantage of an electronic claims submission? A. Claims are expedited. B. Claims are scrubbed. C. Claims are clean. D. Claims are paid. Answer Claims are expedited
- Which describes a CPT modifier that is used to indicate a provider super- vised and interpreted a radiology procedure? A. Technical component. B. Professional component. C. Descriptive qualifier. D. Physical status. Answer Professional component
- A specialist is assisting a patient who has a capitatef HMO and presented to the office with a sinus infection. The specialist should identify that which of the following is a statement that is true regarding a capitated HMO?
B. It's a meeting between the provider and patient's family. C. It's when a provider requests medical advice from a specialist. D. It's a meeting between the provider in a third-party payer. Answer It's when a provider request medical advice from a specialist
- The provider charges $135 for a visit. The third-party payer usual custom- ary reasonable amount is $120 with a 20% coinsurance. Which of the following is the patient's responsibility.? A. $ B. $ C. $ D. $ Answer $
- When should a specialist initiate the collection of information needed to process a payments insurance claim form? A. When a patient signs the HIPAA form at check-in. B. When the patient contacts the providers office and schedule an appoint- ment. C. When the patient pays the co-pay or deductible. D. When the patient checks out of the providers office. Answer
When the patient contact the provider's office and schedule an appointment
- A provider's office receives a subpoena requesting medical documenta- tion form for a patient's medical record. After confirming the correct autho- rization which of the following action should a specialist take? A. Send a patient demographic information from the dates of service request- ed. B. Send a medical information pertaining to the dates of service requested. C. Send patient financial record ledger from dates of service requested. D. Send claims pertaining to the date of service as requested. Answer Send a medical information pertaining to the dates of service as requested
- Which of the following terms describes the removal of the eye, adnexa and bony structure? A. Evisceration B. Enucleation C. Exenteration D. Exploration Answer Exenteration
- Z codes are used to identify which of the following? A. Behavioral disorders. B. Digestive diseases.
Answer Wounds should be grouped by anatomic site and coded in order of complexity
- Which of the following reasons should've claim be resubmitted? A. The software claims review process indicates the claim is not complete B. The claim needed authorization C. The claim requires an attachment to support medical necessity D. The claim has been adjudicated Answer The claim requires an attachment to support medical necessity
- A specialist is preparing an accounts receivable aging report.The specialist should expect the report to include which of the following? A. Rejected claims organized by payer B. Lost claims organized by pair C. Paid balances organized by date D. Outstanding balances organized by date Answer Outstanding balances organized by date
- A specialist is filing a CMS Dash 1500 claim form for a patient who has private insurance. The specialist should recognize that a signature approving assignment of benefits indicates which of the following? A. Payer should reimburse the patient for a claim, with the exception of co-pays and
deductibles B. The provider will except the payer reimbursement as full payment with exception of co-pays and deductibles C. The pair should send reimbursement directly to the provider with the exception of co-pays and deductibles D. The provider should build a patient for any difference between the amount billed and reimbursed by the payer Answer The payer should send reimbursement di- rectly to the provider with the exception of co-pays and deductibles
- A specialist received a denial for payment from TRICARE for services provided in the emergency department while a provider was on a call. The provider is not a participating provider of TRICARE. Which of the following actions must a specialist take to process an appeal payment? A. File a non-availability request form. B. Request reconsideration C. Contact the patient for assistance. D. Inquire through the online tri-care portal. Answer Contact the patient for further assistance
- In an outpatient setting which of the following is used as a financial report of all services provider to patients? A. Encounter form
B. Autumn mobile insurance providers. C. Health care clearing houses. D. Educational facilities. Answer Health care clearinghouse
- A patient who recently received care from an Endo chronologist is being referred to an infectious disease specialist. Which of the following types of referrals does the patient need from the endocrinologist? A. A formal referral B. A direct referral C. Tertiary referral D. Self referral Answer Tertiary care referral
- A specialist is reviewing a remittance advice that has $100 deductible for one of the claims. The provider asked the specialist to write it off. Which describes this scenario? A. Fraud. B. Abuse. C. Adjudication D. Spend down Answer Fraud
- Which of the following prohibits a provider from referring a patient to a clinic lab service in which the provider has a financial interest? A. Federal anti-kickback statute. B. Health insurance portability and accountability act. C. Consolidated omnibus budget reconciliation act. D. Stark law Answer Stark law
- A specialist is appealing a Medicare denial. Which is the first step of the appealing process? A. Reconsideration. B. Medicare appeals console review. C. Judicial review. D. Redetermination Answer Redetermination
- A specialist is reviewing modifier use with a new employee. Which of the following scenarios awards the use of a modifier? A.Fracture of the left femur. B. Splinting of the fourth digit on the left foot. C. Recurrent inguinal hernia. D. Insertion of a contraceptive implant in the right arm Answer Splinting of the fourth digit on the left foot
A. Procedural codes used. B. Provide her name. C. Phone number. D. Diagnosis. Answer Phone number
- Which of the following is true regarding Medicaid eligibility? A. Eligibility of dependents are automatic. B. Providers who accept Medicare must except Medicaid. C. Patient eligibility is determined at each visit. D. Patient eligibility begins at 65 years of age. Answer Eligibility is determined at each visit
- A specialist identifies a CPT code that is routinely being denied by a third- party payer. Which of the following types of reviews for the specialist perform? A. Perspective review. B. Retrospective review. C. Preadmission review. D. Concurrent review. Answer Retrospective review
- The star symbol in the CPT coding manual is used to indicate which of the following?
A. A new code. B. An exception from the use of modifier 51. C. A revised code. D. Telemedicine. Answer Telemedicine
- A patient got a bill because third-party payer denied the claim. Which action should the specialist take? A. Tell the patient to resubmit the claim to the third-party payer. B. Inform the patient for the reason of the denial. C. Tell the patient to speak with the provider. D. Tell the patient the third-party payer will follow up. Answer Inform the patient for the reason of the denial
- Which entities are required to follow HIPAA rules and regulations? A. Government insurance agencies, banks in long-term care facilities. B. Clearinghouse, health insurance companies and billing services. C. Dentists, providers, retail stores. D. Pharmacies, chiropractors, and service stations. Answer Clearinghouse, health in- surance companies and billing services
- A specialist discovers that one private payer has not reimburse the provider for any claims in the past year. Who should the specialist report this to?
patient must see PCP to be referred to an in network doctor. What type of insurance does this patient have? A. PPO. B. HMO. C. Indemnity. D. POS Answer HMO
- A specialist is reviewing a delinquent claim and discovers that a third-party payer paid a claim but applied it to the incorrect provider.The third-party payer will reimburse the payment once in proper payment is recouped. which term describes the claim status? A. Payment error B. Denied C. Rejected D. Suspended Answer Suspended
- Explanation of benefits states to build amount was $180. The allowed amount is $60. The patient is required to pay a $20 co-pay. What will the insurance check read? A. $ B. $
C. $
D. $
Answer $
- The claim is being submit it was a transposed insurance member ID number and returned to the provider. Which of the following describes the status to be assigned to the claim by a third-party payer? A. suspended B. Pending C. Denied D. Invalid Answer Invalid
- Especialist is reviewing a delinquent claim. which of the following should be the specialist first action? A. Verify the age of the account. B. Query the third-party payer. C. Obtain the claim status. D. Resubmit the claim Answer Verify the age of the account
- A specialist is preparing an appeal in response to a denial by a third-party pier for lack of medical necessity. Which of the following should a specialist included with the letter to indicate medical necessity?
potential reason for the reduce amount of payment? A. The claim indicated an incorrect place of service B. Claim missing demo- graphic information C. Coordination of benefits wasn't updated D. Claim was for a work related injury Answer The claim indicated an incorrect place of service
- A specialist discovers a suspicious billing activity that may be fraud in the workplace. Which of the following action should be taken? A. Contact the office of Inspector General B. Call the US Department of health and human services anonymous hotline C. Address it with the provider D. Notify the patient Answer Call the US Department of Health and Human Services anonymous hotline
- Which of the following editing system should a specialist reference to determine if supplies and materials should be assigned to report a surgical trade during an ambulatory procedure? A. Medically unlikely edit B. National correct coding initiative C. Local coverage determination D. National coverage determination Answer National correct coding initiative
- Unlisted calls can be found in which location of the manual CPT Answer In the guidelines prior to each section
- Which of the following symbols indicates an add-on in the CPT manual? A. a lightning bolt B. A star
