NHA CBCS EXAM 2023-2024 ACTUAL EXAM 200 QUESTIONS
AND CORRECT ANSWERS (DETAILED AND VERIFIED
ANSWERS) |ALREADY GRADED A+
A patient has a diagnosis of chest pain. The billing and coding
specialist should link the diagnosis to the procedure in which of the
following blocks on the CMS- 1500 form – ANSWER- 24D
A provider’s office is being investigated for fraud. Which of the
following processes will be reviewed first – ANSWER- Compliance Plan
Which of the following entities works with Centers for Medicare and
Medicaid services to prevent over payment – ANSWER- Medicaid Integrity
contractors
Which of the following actions by a billing and coding specialist is
insurance abuse – ANSWER- Using a health insurance identification
number other than the patients to ensure payments
Which of the following refers to payers electronically transferring date
in order to facilitate coordination of benefits on a clean claim – ANSWERCrossover
Which of the following is responsible for the health care of its
policyhold- ers and identifies health insurance, facilities, providers, or
health systems? – ANSWER- Managed care Organization
A patient who has TRICARE is seen in the office for a diagnostic test.
The test is $500, and the allowable amount is $250. The patient has a 20%
cost share, a deductible of $1000, and a catastrophic cap benefit that have
all been met. How much should the billing specialist adjust on this visit –
ANSWER- $200
Which of the following is the amount that the patient is financially
respon- sible for before the insurance policy provides coverage – ANSWERDeductible
The balances listed on an insurance aging report represent which of
the following – ANSWER- Outstanding amounts owed to the practice<\/p>\n\n\n\n
To ensure all claims are being submitted and received, a billing and
coding specialist should document all claims processing on which of
the following – ANSWER- An aging insurance report
Which of the following terms describes a procedure that visualizes
the inside of a knee – ANSWER- Arthrography
The field ” Insured’s ID Number” located on the CMS-1500 claim form
is used to report which of the following pieces of information – ANSWER- Policy
Number
A certified billing and coding specialist should always check to see that
the patient registration form includes which of the following – ANSWER- Social
security number
A billing and coding specialist who bills for services that are not undertaken at the
current appointment is performing which of the following – ANSWER- Fraud
What is a claim called when the billing and coding specialist checks off
both Medicare and Medicaid in Block 1 on the CMS-1500 claim form – ANSWERCross over claim
A patient is informed that they are required to pay a predetermined fee
at the time of service. This fee is known as which of the following terms –
ANSWER- CoPay
When identical procedures or services are preformed on the same day,
which of the following should the billing and coding specialist update on
the CMS-1500 form – ANSWER- Modifier -59
Which of the following terms describes the transmission of data
for processing by payer or clearing house – ANSWER- Claims
Submission
Which of the following reports is an analysis of accounts
receivable indicating 60,90, and 120 days past due – ANSWER- Account
aging report
A patient has changed policies and her coverage is now with her<\/p>\n\n\n\n
partner. Which of the following information from the partner is required t
bill the patient’s claims – ANSWER- Policy number
Which of the following should be placed in a patient’s financial file – ANSWERnsurance identification
Which of the following diagnoses can be found in the neoplasm table – ANSWERBasal cell carcinoma
A patient has a $300 deductible and a 20% coinsurance. The charge
amount and allowed amount are both $2,000, and the health plan has
paid 80%. Which of the following is the patients responsibility – ANSWER- $340
A Medicare patient with a Medigap policy is charged $100 for an office
visit. The approved amount is $60 and the patient has met their deductible.
How much should the billing and coding specialist post as a write off – ANSWER-
$40
Which of the following describes the process of calculating a
patient’s liability for a procedure – ANSWER- Predetermination
After a billing a coding specialist submits a claim, what is Medicare’s
time limit for the submission – ANSWER- 90 days from the date of service
Which of the following terms describes the process of identifying the maximum
dollar amount that an insurance carrier will pay for a procedure? – ANSWER- Preapproval
Which of the following government agencies has launched a website
to help consumers identity sources of public and private coverage – ANSWERDHHS
A sinus procedure with a health maintenance organization (HMO)
requires which of the following – ANSWER- Preauthorization
A billing and coding specialist has received a remittance advice in
which the allowed amount was 70$ on a charge amount of $110 and the
patient has a coinsurance of 10%. Which of the following amounts should
the specialist use as an adjustment – ANSWER- $35<\/p>\n\n\n\n
A provider accepts pre-established payments for providing services to
enrollees for 1 year. Which of the following plans does this describe – ANSWERPPO
A patient’s progress notes indicates that she is primigravida. Which
of the following describes the patient’s condition – ANSWER- Pregnant for
the first time
A paper claim is registered due to missing information. Which of the
following actions should the billing and coding specialist take once the
claim is corrected – ANSWER- Resubmit the corrected claim
After identifying a code in the alphabetic index, a billing and coding
specialist should verify the code using which of the following resources –
ANSWER- Tabular List
To verify TRICARE eligibility, the provider electronically accesses
which of the following – ANSWER- Defense Enrollment Eligibility Reporting
system
At what point in the billing process is an explanation of benefits
(EOB) sent to the patient – ANSWER- After the claim gets paid or denied
A patient has primary and secondary insurance. If a patient receives
ser- vices totaling $100, which of the following prevents both insurance
payers from paying $100 for the service – ANSWER- Coordination of
benefits
Which of the following types of insurance coverage requires a
signed Advanced Beneficiary Notice of Noncoverage (ABN) form is
payment is expected to be denied – ANSWER- Medicare
A new patient who has a preferred provider organization (PPO)
presents to the office reporting stomach pains. For which of the following
reasons does the patient have to pay out of pocket for this office visit – ANSWERhe patient has not met the deductible
Which of the following is a state-mandated third-party payer – ANSWERMedicare
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