NHA CBCS Exam Questions and Answers Latest (2024 / 2025) (100% Verified Answers by Expert)
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A nurse is reviewing a patients lab results prior to discharge and discovers an elevated glucose level. Which of the following health care providers should be altered before the nurse can proceed with discharge planning?
On the CMS-1500 Claims for, blocks 14 through 33 contain information about which of the following?
A provider performs an examination of a patient’s throat during an office visit. Which of the following describes the level of the examination?
“The symbol “”O”” in the Current Procedural Terminology reference is used to indicate which of the following?”
Which of the following is the portion of the account balance the patient must pay after services are rendered and the annual deductible is met?
The billing and coding specialist should divide the evaluation and management code by which of the following?
“The standard medical abbreviation “”ECG”” refers to a test used to access which of the following body systems?”
In the anesthesia section of the CPT manual, which of the following are considered qualifying circumstances?
As of April 1st 2014, what is the maximum number of diagnosis that can be reported on the CMS-1500 claim form before a further claim is required?
When submitting a clean claim with a diagnosis of kidney stones, which of the following procedure names is correct?
Which of the following is one of the purposes of an internal auditing program in a physician’s office?
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?
Which of the following options is considered proper supportive documentation for reporting CPT and ICD codes for surgical procedures?
Which of the following actions should be taken first when reviewing delinquent claims?
Which of the following components of an explanation of benefits expedites the process of a phone appeal?
A claim can be denied or rejected for which of the following reasons?
To be compliant with HIPAA, which of the following positions should be assigned in each office?
All e-mail correspondence to a third party payer containing patients’ protected health information (PHI) should be
A billing and coding specialist should understand that the financial record source that is generated by a provider’s office is called a
Which of the following includes procedures and best practices for correct coding?
HIPAA transaction standards apply to which of the following entities?
Which of the following actions should be taken if an insurance company denies a service as not medically necessary?
A patient with a past due balance requests that his records be sent to another provider. Which of the following actions should be taken?
A participating BlueCross/ BlueShield (BC/BS) provider receives an explanation of benefits for a patient account. The charged amount was $100. BC/BS allowed $40 to the patients annual deductible. BC/BS paid the balance at 80%. How much should the patient expect to pay?
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.
Which of the following is used to code diseases, injuries, impairments, and other health related problems?
Urine moves from the kidneys to the bladder through which of the following parts of the body?
Threading a catheter with a balloon into a coronary artery and expanding it to repair arteries describes which of the following procedures?
A patient’s portion of the bill should be discussed with the patient before a procedure is performed for which of the following reasons?
Which of the following actions by the billing and coding specialists prevents fraud?
Which of the following information is required on a patient account record?
A claim is submitted with a transposed insurance member ID number and returned to the provider. Which of the following describes the status that should be assigned to the claim by the carrier?
Which of the following should the billing and coding specialist complete to be reimbursed for the provider’s services?
Which of the following is HIPAA compliance guideline affecting electronic health records?
Which of the following is the purpose of precertification
Which of the following should the billing and coding specialist include in an authorization to release information?
Which of the following actions should the billing and coding specialist take if he observes a colleague in an unethical situation?
When posting payment accurately, which of the following items should the billing and coding specialist include?
A dependent child whose parents both have insurance coverage comes to the clinic. The billing and coding specialist uses the birthday rule to determine which insurance policy is primary. Which of the following describes the birthday rule?
Which of the following statements is true regarding the release of patient records?
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?
Which of the following do physicians use to electronically submit claims?
When coding on the UB-04 form, the billing and coding specialist must sequence the diagnosis codes according to the ICD guidelines. Which of the following is the first listed diagnosis code?
A patient has AARP as secondary insurance. In which of the following blocks on the CMS-1500 claim form should this information be entered?
According to HIPAA standards, which of the following identifies the rendering provider on the CMS-1500 claim form in Block 24j?
Which of the following is the function of the respiratory system?
Which of the following provisions ensures that an insured’s benefits from all insurance companies do not exceed 100% of allowable medical expenses?
Which of the following is the verbal or written agreement that gives approval to some action, situation, or statement, and allows the release of patient information?
A deductible of $100 is applied to a patient’s remittance advice. The provider requests the account personnel write it off. Which of the following terms describes this scenario?
A coroner’s autopsy is comprised of which of the following examinations?
Which of the following is the advantage of electronic claim submission?
A patient presents to the provider with chest pain and SOB. After an unexpected ECG result, the provider calls a cardiologist and summarizes the patient’s symptoms. What portion of HIPAA allows the provider to speak to the cardiologist prior to obtaining the patient’s consent?
A physician ordered a comprehensive metabolic panel for a 70 year old patient who has Medicare as her primary insurance. Which of the following forms is required so the patient knows she may be responsible for payment?
Which of the following does a patient sign to allow payment of claims directly to the provider?
All dependents 10 year of age or older are required to have which of the following for TRICARE?
Medigap coverage is offered to Medicare beneficiaries by which of the following?
An insurance claims register (aged insurance report) facilitates which of the following?
Which of the following describes an obstruction of the urethra?
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?
On the CMS-1500 claim form, Blocks 1 through 13 include which of the following
Which of the following is the primary function of the heart?
Which of the following actions should be taken when a claim is billed for a level four office visit and paid at a level three?
Which of the following types of claims is 120 days old?
Which of the following shows outstanding balances?
Which part of Medicare covers prescriptions?
In which of the following departments should a patient be seen for psoriasis?
Which of the following is an example of a violation of an adult patient’s confidentiality?
Which of the following describes the reason for a claim rejection because of Medicare NCCI edits?
Which of the following sections of the medical record is used to determine the correct Evaluation and Management code used for billing and coding?
Which of the following is a private insurance carrier?
Which of the following information should the billing and coding specialist input into Block 33a on the CMS-1500 claim form?
Which of the following forms should the billing and coding specialist transmit to the insurance carrier for reimbursement of inpatient hospital services?
A patient who has a primary malignant neoplasm of the lung should be referred to which of the following specialists?
Why does correct claim processing rely on accurately completed encounter forms?
Which of the following planes divides the body into left and right?
A patient is upset about a bill she received. Her insurance company denied the claim. Which of the following actions is an appropriate way to handle the situation?
Which of the following describes a delinquent claim?
When completing a CMS-1500 paper claim form, which of the following is an acceptable action for the billing and coding specialist to take?
Which of the following medical terms refers to the sac that encloses the heart?
Which of the following is considered the final determination of the issues involving settlement of an insurance claim?
A form that contains charges, DOS, CPT codes, ICD codes, fees, and copayment information is called which of the following?
Which of the following privacy measures ensures protected health information (PHI)?
Which of the following is the purpose of running an aging report each month?
Which of the following actions by a billing and coding specialist would be considered fraud?
Which of the following claims is submitted and then optically scanned by the insurance carrier and converted to an electronic form?
Which of the following blocks requires the patient’s authorization to release medical information to process a claim?
Which of the following blocks should the billing and coding specialist complete on the CMS-1500 claim form for procedures, services, or supplies?
The unlisted codes can be found in which of the following locations in the CPT manual?
A physician is contracted with an insurance company to accept the allowed amount. The insurance company allows $80 of a $120 billed amount, and $50 of the deductible has been met. How much should the physician write off the patient’s account?
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?
“The “”><“” symbol is used to indicate new and revised text other than which of the following?”
Which of the following indicates a claim should be submitted on paper instead of electronically?
Which of the following terms describes when a plan pays 70% of the allowed amount and the patient pays 30%?
Claims that are submitted without an NPI number will delay payment to the provider because
Ambulatory surgery centers, home health care, and hospice organizations use the
Which of the following color formats is acceptable on the CMS-1500 claim form?
Which of the following statements is correct regarding a deductible?
A provider charged $500 to a 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?
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?
“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?”
After a 3rd party payer validates a claim, which of the following takes place next?
HIPAA transaction standards apply to which of the following entities?
Which of the following is the initial step in processing a workers’ compensation claim?
The provision of health insurance policies that specifies which coverage is considered primary or secondary is called which of the following?
Medicare enforces mandatory submission of electronic claims for most providers. Which of the following providers is allowed to submit paper claims to medicare?
When submitting claims, which of the following is the outcome if block 13 is left blank?
Patient charges that have not been paid will appear in which of the following?
A billing and coding specialist needs to know how much Medicare paid on a claim before billing secondary insurance. To which of the following should the specialist refer?
A billing and coding specialist should add modifier -50 to codes when reporting which of the following?
In 1995 and 1997, which of the following introduced documentation guidelines to Medicare carriers to ensure that services paid for have been provided and were medically necessary?
Which of the following is allowed when billing procedural codes?
The destruction of lesions using cryosurgery would use which of the following treatments?
When a patient has a condition that is both acute and chronic how should it be reported?
Which of the following describes the content of a medical practice aging report?
After reading a provider’s notes about a new patient, a coding specialist decides to code for a longer length of time than the actual office visit. Which of the following describes the specialist’s action?
A claim is denied because the service was not covered by the insurance company. Upon confirmation of no errors on the claim, which of the following describes the process that will follow the denial?
A prospective billing account audit prevents fraud by reviewing and comparing a completed claim form with which of the following documents?
Which of the following security features is required during transmission of protected health information and medical claims to third party payers?
Which of the following acts applies to the Administrative Simplification guidelines?
Z codes are used to identify which of the following?
Which of the following modifiers should be used to indicate a professional service has been discontinued prior to completion?
When an electronic claim is rejected due to incomplete information, which of the following should the medical billing specialist take?
Which of the following is an example of electronic claim submission?
Test results indicated that no abnormalities were found in the brain and the brain’s electrical activity patterns are normal. Which of the following tests was used to conduct this exam?
When billing a secondary insurance company, which block should the billing and coding specialist fill out on the CMS-1500 claim form?
Which of the following actions should the billing and coding specialist take to effectively manage accounts receivable?
What is the maximum number of ICD codes that can be entered on a CMS-1500 claim form as of February 2012?
Which of the following actions should the billing and coding specialist take to prevent fraud and abuse in the medical office?
For which of the following time periods should the billing and coding specialist track unpaid claims before taking follow up action
A beneficiary of a Medicare/Medicaid crossover claim submitted by a participating provider is responsible for which of the following percentages?
A biller will electronically submit a claim to the carrier via which of the following?
When a physician documents a patient’s response to symptoms and various body systems, the results are documented as which of the following?
Which of the following is a correct entry of a charge of $140 in Block 24F of the CMS-1500 claim form?
Which of the following situations constitutes a consultation?
If a patient has osteomyelitis he has a problem with which of the following areas?
Which of the following forms must the patient or representative sign to allow the release of protected health information?
Block 17b on the CMS-1500 claim form should list which of the following information?
Which of the following was developed to reduce Medicare program expenditures by detecting inappropriate codes and eliminating improper coding practices?
Which of the following describes the status of a claim that does not include required preauthorization for a service?
Which of the following parts of the body system regulates immunity?
Which of the following is used by providers to remove errors from claims before they are submitted to 3rd party payers?
A provider receives reimbursement from a 3rd party payer accompanied by which of the following documents?
Which of the following is the 3rd stage of the life cycle of a claim?
Which of the following blocks on the CMS-1500 claim form is required to indicate a workers’ compensation claim?
2 providers from the same practice visit a patient in the emergency department using the same CPT code. The claim may be denied due to which of the following reasons?
A patient has an emergency appendectomy while on vacation. The claim is rejected due to the patient obtaining services out of network. Which of the following information should be included in the claim appeal?
Which of the following is a type of claim that will be denied by the 3rd party payer?
Which of the following steps would be part of a physician’s practice compliance program?
A patient has met a Medicare deductible of $150. The patient’s coinsurance is 20% and the allowed amount is $600. Which of the following is the patient’s out of pocket expense?
Which of the following is the primary information used to determine the priority of collection letters to patients?
Which of the following claims would appear on an aging report?
Which of the following is a requirement of some 3rd party payers before a procedure is performed?
Which of the following coding manuals is used primarily to identify products, supplies, and services?
A billing and coding specialist should enter the prior authorization number on the CMS-1500 claim form in which of the following blocks?
Which of the following documents is required to disclose an adult patient’s information?
Which of the following billing patterns is a best practice action?
Behavior plays an important part of being a team player in a medical practice. which of the following is an appropriate action for the billing and coding specialist to take?
A physician is contracted with an insurance company to accept the allowed amount. The insurance company allows $80 of a $120 billed amount, and $50 of the deductible has not been met. How much should the physician write off the patient’s account?
Accepting assignment on the CMS-1500 claim form indicates which of the following?
Which of the following statements is true when determining patient financial responsibility by reviewing the remittance advice?
In an outpatient setting, which of the following forms is used as a financial report of all services provided to patients?
Which of the following is the appropriate diagnosis for a patient who has an abnormal accumulation of fluid in her lower leg that has resulted in swelling?
Which of the following types of health insurance plans best describes a government sponsored benefit program?
Which of the following organizations identifies improper payments made on CMS claims?
Which of the following information is required to include on an Advance Beneficiary Notice (ABN) form?
Which of the following blocks on CMS-1500 claim form is used to bill ICD codes?
Which of the following terms is used to communicate why a claim line item was denied or payed differently than it was billed?
Block 32con the CMS form contains what?
A provider’s office requests a subpoena requesting medical documentation from a patient’s medical record. After confirming the correct authorization, which of the following actions should the billing & coding specialist take?
Which of the following is the deadline for a Medicare for claims submission?
Which of the following forms does a 3rd party payer require for physician services?
Which of the following is an example of Medicare abuse?
Which of the following terms refers to the difference between the billed and allowed amounts?
Which of the following HMO managed care services requires a referral?
Which of the following explains why Medicare will deny a particular service or procedure?
What type of claim is 120 days old?
When reviewing an established patient’s insurance card, the billing and specialist notices a minor change from the existing card on file. Which of the following actions should the billing & coding specialist take?
A husband and wife each have group insurance through their employers. The wife has an appt. with her provider. Which insurance should be used as the primary for this appt?
Which of the following would most likely result in a denial on a Medicare claim?
Which of the following pieces of guarantor information is required when establishing a patient’s financial record?
A provider surgically punctures through 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?
A patient has AARP as secondary insurance. Which block on the CMS 1500 claim form should this information be entered?
A medicare non-participating provider’s approved payment for $200 for a lobectomy and the deductible was met. Which amounts is the limiting charge for this?
In the anesthesia section of the CPT manual, which are considered qualifying circumstances?
Which of the following statements is accurate regarding the diagnostic codes in Block 21?
Which of the following parts of Medicare insurance program is managed by private 3rd party insurance providers that have been approved by medicare?
A billing & coding specialist can ensure appropriate insurance coverage for an outpatient procedure by 1st using which of the following processes?
Which of the following is considered fraud?
Which of the following symbols indicates a revised code?
Which of the following entities defines the essential elements of a comprehensive compliance program?
Which of the following is the purpose of coordination of benefits?
A billing & coding specialist submitted a claim to Medicare electronically. No errors were found by the billing software or clearinghouse. Which of the following describes the claim?
Which of the following would result in a claim being denied?
Which of the following standardized formats are used in the electronic filing of claims?
Which of the following describes a 2 digit CPT code used to indicate that the provider supervised & interpreted a radiology procedure?
Which of the following formats are used to submit electronic claims to a 3rd party payer?
Which of the following is true regarding Medicaid?
Which of the following is the maximum # of modifiers that the billing & coding specialists can use on a CMS-1500 claim form in Block 24D?
When the remittance advice is sent from the 3rd party payer to the provider, which of the following actions should the billing and coding specialists perform first?
Which of the following would be a reason a claim would be denied?
The billing and coding specialists should follow the guidelines in the CPT manual for which of the following reasons?
Which of the following options is considered proper supportive documentation for reporting CPT & ICD codes for surgical procedures?
Which of the following blocks on the CMS-1500 claim form is used to accept assignment of benefits?
Which of the following is an example of a remark code from an explanation of benefits document?
“Which of the following describes the term “”crossover”” as it relates to Medicare?”
Rendering Provider ID Number goes on what block on the CMS-1500 claim form?
Which of the following is included in the release of patient information?
Which of the following describes a key component of an evaluation & management service?
Which of the following reports is used to arrange the accounts receivable from the date of service?
Which of the following best describes medical ethics?
An examination of a patient’s knee joint via small incisions & an optical device. Which of the following terms describes this procedure?
Which of the following accurately describes code symbols found in the CPT manual?
Which of the following describes an insurance carrier that pays the provider who rendered services to a patient?
Which of the following prohibits a provider from referring Medicare patients to a clinical laboratory service in which the provider has a financial interest?
Which of the following electronic forms is used to post payments?
For non-crossover claims, the billing & coding specialists should prepare an additional claim for the secondary payer & send it with a copy of which of the following?
When coding a front torso burn, which of the following percentages should be coded?
Which of the following blocks of the CMS-1500 claim form indicates an ICD diagnosis code?
Which of the following national provider identifiers (NPIs) is required from block 33A of a CMS-1500 claim form?
Which of the following causes a claim to be suspended?
Which of the following terms is used to describe the location of the stomach, the spleen, part of the pancreas, part of the liver, & part of the small & large intestines?
Which of the following actions should the billing and coding specialist take when submitting a claim to Medicaid for a patient who has primary & secondary coverage?
National provider #
When a 3rd party payer requests copies of patient information related to a claim, the billing and coding specialists must make sure which of the following is included in the patient’s file?
A patient who has an HMO insurance place needs to see a specialists for a specific problem. From which of the following should the patient obtain the referral?
Which of the following organizations fights waste, fraud, and abuse in medicare and Medicaid?
When submitting claims, which of the following is the outcome if block 13 is left blank?
“A billing & coding specialists is reviewing a CMS-1500 claim form. “”The assignment of benefits box”” has been checked “”yes””. The checked box indicates which of the following?”
A bene
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