{"id":117099,"date":"2023-08-27T19:32:49","date_gmt":"2023-08-27T19:32:49","guid":{"rendered":"https:\/\/learnexams.com\/blog\/?p=117099"},"modified":"2023-08-27T19:32:51","modified_gmt":"2023-08-27T19:32:51","slug":"nha-cbcs-study-bundle-package-deal-with-questions-and-answers-2022-2023-verified-bundle","status":"publish","type":"post","link":"https:\/\/www.learnexams.com\/blog\/2023\/08\/27\/nha-cbcs-study-bundle-package-deal-with-questions-and-answers-2022-2023-verified-bundle\/","title":{"rendered":"NHA CBCS Study Bundle Package Deal With Questions and Answers (2022\/2023) (Verified Bundle)"},"content":{"rendered":"\n<p>1 \/ 10<br>NHA- CBCS EXAM REVIEW<br>2022\/2023(Verified Answers by Expert)<br>1.UROLOGIST\u2714\u2714 A would be the<br>provider who would perform an orchiopexy<br>2.EVALUATION AND MANAGEMENT CODES\u2714\u2714 The first section of<br>the CPT manual is the .<br>3.ALLOWED AMOUNT\u2714\u2714 means the<br>amount of reimbursement an insurance payer and patient agrees to<br>pay a provider.<br>4.PLACE OF SERVICE\u2714\u2714 A billing and coding specialist should<br>determine first, the<br>to determine an appropriate e\/m code.<br>5.LOWER RIGHT QUADRANT\u2714\u2714 The appendix is located in the<br>of the abdomen.<br>6.POLICY NUMBER\u2714\u2714 For a patient whose insurance coverage is from<br>her partner, the is required to bill her claim.<\/p>\n\n\n\n<p>2 \/ 10<br>7.V CODE\u2714\u2714 An exposure to tuberculosis requires a<br>.<br>8.GUARANTOR INFORMATION\u2714\u2714 A billing and coding specialist should<br>use<br>when<br>transmitting a claim for a minor without health insurance.<br>9.OFFICE OF THE INSPECTOR GENERAL\u2714\u2714 The<br>investigates cases of fraud<br>and pre- pares a referral for prosecution.<br>10.CLEAN CLAIM\u2714\u2714 An insurance claim is considered a<br>when further reviewed by the<br>insurance company, is not necessary before submitting the claim.<br>11.PERFORM INTERNAL AUDITS TO MONITOR THE<br>BILLING PROCESS\u2714\u2714 A billing and coding specialist<br>should<br>to identify areas of<br>risk as- sociated with billing compliance.<br>12.THE BODY MAINTAINS NORMAL BALANCE AND FUNCTION\u2714\u2714 When<\/p>\n\n\n\n<p>3 \/ 10<br>, then it is said to be<br>in a state of homeostasis.<br>13.ANSI ASC X12 837\u2714\u2714 The is<br>an example of an electronic claim format.<br>14.PATIENT&#8217;S DEDUCTIBLE\u2714\u2714 The<br>information is included<br>in an electronic remittance advice.<\/p>\n\n\n\n<p>1 \/ 16<br>NHA CBCS EXAM REVIEW<br>2022\/2023(Verified Answers by Expert)<br>1.Which of the following Medicare policies determines if a particular item<br>or service is covered by Medicare\u2714\u2714\u2714\u2714 National Coverage<br>Determination (NCD)<br>2.A patient&#8217;s employer has not submitted a premium payment. Which of<br>the following claim statuses should the provider receive from the thirdparty payer\u2714\u2714\u2714\u2714 Denied<br>3.A billing and coding specialist should routinely analyze which of the<br>following to determine the number of outstanding claims\u2714\u2714\u2714\u2714 Aging<br>report<br>4.Which of the following should a billing and coding specialist use to<br>submit a claim with supporting documents\u2714\u2714\u2714\u2714 Claims attachment<br>5.Which of the following terms is used to communicate why a claim line<br>item was denied or paid differently than it was billing\u2714\u2714\u2714\u2714 Claim<br>adjustment codes<br>6.On a CMS-1500 claim form, which of the following information should<br>the billing and coding specialist enter into Block 32\u2714\u2714\u2714\u2714 Service facility<br>location information<br>7.A provider&#8217;s office receives a subpoena requesting medical documenta-<\/p>\n\n\n\n<p>2 \/ 16<br>tion from a patient&#8217;s medical record. After confirming the correct<br>authoriza- tion, which of the following actions should the billing and<br>coding specialist take\u2714\u2714\u2714\u2714 Send the medical information pertaining to<br>the dates of service requested<br>8.Which of the following is the deadline for Medicare claim<br>submission\u2714\u2714\u2714\u2714 12 months from the date of service<br>9.Which of the following forms does a third-party payer require for<br>physician services\u2714\u2714\u2714\u2714 CMS-1500<br>10.A patient who is an active member of the military recently returned from<br>overseas and is in need of specialty care. The patient does not have<br>anyone designed with power of attorney. Which of the following is<br>considered a HIPAA violation\u2714\u2714\u2714\u2714 The billing and coding specialist<br>sends the patient&#8217;s records to the patient&#8217;s partner.<br>11.Which of the following terms refers to the difference between the<br>billing and allowed amounts\u2714\u2714\u2714\u2714 Adjustment<\/p>\n\n\n\n<ol class=\"wp-block-list\" start=\"12\">\n<li>Which of the following HMO managed care services requires a<br>referral?-<br>: Durable medical equipment<br>13.Which of the following explains why Medicare will deny a<br>particular service or procedure\u2714\u2714\u2714\u2714 Advance Beneficiary Notice<br>(ABN)<br>14.Which of the following types of claims is 120 days old\u2714\u2714\u2714\u2714<br>Delinquent<\/li>\n<\/ol>\n\n\n\n<p>3 \/ 16<br>15.When reviewing an established patient&#8217;s insurance card, the billing<br>and coding specialist notices a minor change from the existing card on<br>file. Which of the following actions should the billing and coding<br>specialist take\u2714\u2714\u2714\u2714 Photocopy both sides of the new card<br>16.A husband and wife each have group insurance through their<br>employers. The wife has an appointment with her provider. Which<br>insurance should be used as primary for the appointment\u2714\u2714\u2714\u2714 The<br>wife&#8217;s insurance<br>17.Which of the following would most likely result in a denial on a<br>Medicare claim\u2714\u2714\u2714\u2714 An experimental chemotherapy medication for a<br>patient who has stage III renal cancer<br>18.Which of the following pieces of guarantor information is required<br>when establishing a patient&#8217;s financial record\u2714\u2714\u2714\u2714 Phone number<br>19.A provider surgically punctures through the space between the<br>patient&#8217;s ribs using an aspirating needle to withdraw fluid from the chest<br>cavity. Which of the following is the name of this procedure\u2714\u2714\u2714\u2714<br>Pleurocentesis<br>20.A patient has AARP as secondary insurance. In which of the<br>following blocks on the CMS-1500 claim form should the information be<br>entered\u2714\u2714\u2714\u2714 &#8211; Block 9<br>21.A Medicare non-participating (non-PAR) provider&#8217;s approved payment<br>amount is $200 for a lobectomy and the deductible has been met. Which<br>of the following amounts is the limiting charge for this procedure\u2714\u2714\u2714\u2714<br>$230<\/p>\n\n\n\n<p>4 \/ 16<br>**A non-PAR who does not accept assignment, can collect a maximum<br>of 15% (the limiting charge) over the non-PAR Medicare fee schedule<br>amount.<br>22.In the anesthesia section of the CPT manual, which of the following<br>are considered qualifying circumstances\u2714\u2714\u2714\u2714 Add-on codes<br>23.Threading a catheter with a balloon into a coronary artery and<br>expanding it to repair arteries describes which of the following<br>procedures\u2714\u2714\u2714\u2714 Angioplasty<br>24.Which of the following actions by a billing and coding specialist<br>would be considered fraud\u2714\u2714\u2714\u2714 Billing for services not provided<br>25.Which of the following statements is accurate regarding the<br>diagnostic codes in Block 21\u2714\u2714\u2714\u2714 These codes must correspond to<br>the diagnosis pointer in Block 24E<br>26.Which of the following parts of the Medicare insurance program is managed by private, third-party insurance providers that have been approved<br>by Medicare\u2714\u2714\u2714\u2714 Medicare Part C<\/p>\n\n\n\n<p>1 \/ 11<br>NHA CBCS PRACTICE TEST<br>2022\/2023(Verified Answers by Expert)<br>1.2. A claim is submitted with a transposed insurance member ID number<br>&amp; returned to the provider. This describes the status that should be<br>assigned to the claim by the carrier\u2714\u2714\u2714\u2714INVALID<br>2.3. Medigap coverage is offered to Medicare beneficiaries<br>by\u2714\u2714\u2714\u2714PRIVATE THIRD-PARTY PAYER<br>3.4. This provision ensures that an insured&#8217;s benefits from all insurance<br>companies does not exceed 100% of allowable medical: Coordination of<br>ben- efits<br>4.5. A coroner&#8217;s autopsy is comprised of which examination\u2714\u2714\u2714\u2714Gross<br>exami- nation.<br>5.6. This statement is true regarding the release of patient<br>records\u2714\u2714\u2714\u2714Patient access to psychotherapy notes may be<br>restricted.<\/p>\n\n\n\n<ol class=\"wp-block-list\" start=\"6\">\n<li>7. Actions by a billing &amp; coding specialist would be considered<br>fraud\u2714\u2714\u2714\u2714-<br>Billing for services not provided.<br>7.8. The components of an explanation of benefits expedites the process<br>of a phone appeal\u2714\u2714\u2714\u2714Claim control number.<br>8.9. On the CMS-1500 claim form, blocks 14 through 33 contain<\/li>\n<\/ol>\n\n\n\n<p>2 \/ 11<br>information of?.: The patient&#8217;s condition &amp; the provider&#8217;s information<\/p>\n\n\n\n<ol class=\"wp-block-list\" start=\"10\">\n<li>A billing &amp; coding specialist should understand that the financial<br>record source that is generated by a provider&#8217;s office is called<br>a\u2714\u2714\u2714\u2714Patient Ledger Account.<br>10.11. The medical terms refer to the sac that endoses the<br>heart\u2714\u2714\u2714\u2714Pericardi- um.<br>11.12. HIPAA transaction standards apply to\u2714\u2714\u2714\u2714Health care<br>clearinghouse.<br>12.13. All dependents 10 years of age or older are required to have which<br>of the following for TRICARE\u2714\u2714\u2714\u2714Military identification.<br>13.14. The standard medical abbreviation &#8220;ECG&#8221; refers to a test used<br>to assess\u2714\u2714\u2714\u2714Cardiovascular system.<br>14.15. An example of a violation of an adult patient&#8217;s<br>confidentiality\u2714\u2714\u2714\u2714Patient information was disclosed to the patient&#8217;s<br>parent without consent.<br>15.16. Claims that are submitted without an NPI number will delay<br>payment to the provider because\u2714\u2714\u2714\u2714the number is needed to identify<br>the provider<\/li>\n<\/ol>\n\n\n\n<p>3 \/ 11<br>16.17. Sections of the medical record is used to determine the correct<br>Evaluation &amp; Management code used for billing &amp; coding\u2714\u2714\u2714\u2714History &amp;<br>physical<br>17.18. Actions should be taken if an insurance company denies a service<br>as not medically necessary\u2714\u2714\u2714\u2714Appeal the decision with a provider&#8217;s<br>report.<br>18.19. Missing #19: misssing<br>19.20. The function of the respiratory system\u2714\u2714\u2714\u2714Oxygenating blood<br>cells<br>20.21. This describes a delinquent claim\u2714\u2714\u2714\u2714The claim is overdue for<br>payment.<br>21.22. What actions should the billing &amp; coding specialist take if he<br>observes a colleague in an unethical situation\u2714\u2714\u2714\u2714Report the incident<br>to a supervisor.<br>22.23. A participating Blue Cross\/Blue Shield (BC\/BS) provider receives an<br>explanation of benefits for a patient account. The charged amount was<br>$100. BC\/BS allowed $80 &amp; applied $40 to the patient&#8217;s annual deductible.<br>BC\/BS paid the balance at 80%. How much should the patient expect to<br>pay\u2714\u2714\u2714\u2714$48.<br>23.24. This statement is correct regarding a deductible\u2714\u2714\u2714\u2714The<br>deductible is the patient&#8217;s responsibility.<br>24.25. A physician ordered a comprehensive metabolic panel for a<br>70-year-old patient who has Medicare as her primary insurance. This form<\/p>\n\n\n\n<p>1 \/ 33<br>CBCS Exam Study Guide 2022\/2023<br>(Verified Answers by Expert)<br>1.Medical Billing &amp; Coding as a Career: *Claims assistant professional or<br>claims manager, *Coding Specialist, * Collection Manager, *Electronic<br>Claims Proces- sor, *Insurance Billing Specialist, * Insurance<br>Coordinator, *Insurance Counselor,<br>*Medical Biller, *Medical &amp; Financial Records Manager, * Billing &amp;<br>Coding Special- ist<br>2.What are Medical Ethics\u2714\u2714\u2714\u2714 Standards of conduct based on moral<br>principle. They are generally accepted as a guide for behavior towards<br>pt&#8217;s, dr&#8217;s, co-workers, the gov, and ins co&#8217;s.<br>3.What does acting within ethical behavior boundaries<br>mean\u2714\u2714\u2714\u2714carrying out one&#8217;s responsibilities w\/ integrity, dignity,<br>respect, honesty, competence, fairness, &amp; trust.<br>4.Compliance regulations\u2714\u2714\u2714\u2714 Most billing-related cases are based on<br>HIPPA and False Claims Act<br>5.Health Insurance Portability &amp; Accountability Act (HIPPA): Enacted in<br>1996, created by the Health Care Fraud &amp; Abuse Control Programenacted to check for fraud and abuse in the Medicare\/Medicaid<br>Programs and private payers<\/p>\n\n\n\n<p>2 \/ 33<br>6.What are the 2 provisions of HIPPA\u2714\u2714\u2714\u2714Title I: Insurance<br>Reform Title II: Administrative Simplification<br>7.What is Title I of HIPPA\u2714\u2714\u2714\u2714Insurance Reform-primary purpose is to<br>provide con- tinuous ins coverage for worker &amp; their dependents when<br>they change or lose jobs. Also *Limits the use of preexisting conditions<br>exclusions *Prohibits discrimination from past or present poor health<br>*Guarantees certain employees\/indv the right to purchase new health<br>ins coverage after losing job *Allows renewal of health ins cov<br>regardless of an indv&#8217;s health cond. that is covered under the<br>particular policy.<br>8.What is Title II of HIPPA\u2714\u2714\u2714\u2714Administrative Simplification-goal is<br>to focus on the health care practice setting to reduce administrative<br>cost &amp; burdens. Has 2<br>parts- 1) development and implementation of standardized healthrelated financial &amp; administrative activities electronically 2)<br>Implementation of privacy &amp; security procedures to prevent the<br>misuse of health info by ensuring confidentiality<\/p>\n\n\n\n<ol class=\"wp-block-list\" start=\"9\">\n<li>What is the False Claims Act (FCA)\u2714\u2714\u2714\u2714Federal law that prohibits<br>submitting a fraudulent claim or making a false statement or<br>representation in connection w\/ a claim. Also protects &amp; rewards<br>whistle-blowers.<br>10.What is the National Correct Coding Initiative (NCCI)\u2714\u2714\u2714\u2714Developed<br>by CMS to promote the national correct coding methodologies &amp; to<br>control improper coding that lead to inappropriate payment of Part B<\/li>\n<\/ol>\n\n\n\n<p>3 \/ 33<br>health ins claims.<\/p>\n\n\n\n<p>4 \/ 33<br>11.How many edits does NCCI include\u2714\u2714\u2714\u27142: 1)Column 1\/Column 2<br>(prev called Comprehensive\/Component) Edits<br>2) Mutually Exclusive Edits<br>12.Column 1\/Column 2 edits (NCCI): Identifies code pairs that should not<br>be billed together b\/c 1 code (Column 1) includes all the services<br>described by another code (Column 2)<br>13.Mutually Exclusive Edits (NCCI): ID&#8217;s code pairs that, for clinical<br>reasons, are unlikely to be performed on the same pt on the same day<br>14.What are the possible consequences of inaccurate coding and<br>incorrect billing\u2714\u2714\u2714\u2714*delayed processing &amp; payment of claims<br>*reduced payments, denied claims *fine and\/or imprisonment<br>*exclusion from payer&#8217;s programs, loss of dr&#8217;s license to practice med<br>15.Who has the task of investigate and prosecuting health care fraud<br>&amp; abuse\u2714\u2714\u2714\u2714The Office of Inspector General (OIG)<br>16.Fraud: knowingly &amp; intentionally deceiving or misrepresenting info<br>that may result in unauthorized benefits. It is a felony and can result<br>in fines and\/or prison.<br>17.Who audits claims\u2714\u2714\u2714\u2714State &amp; federal agencies as well as private<br>ins co&#8217;s<br>18.What are common forms of fraud\u2714\u2714\u2714\u2714billing for services not<br>furnished, un- bundling, &amp; misrepresenting diagnosis to justify<br>payment<br>19.Abuse: incidences or practices, not usually considered fraudulent,<\/p>\n\n\n\n<p>1 \/ 8<br>CBCS Practice Exam 2022\/2023<br>(Verified Answers by Expert)<br>1.A patient presents to the provider with chest pain and shortness of<br>breath. After an unexpected ECG result, the provider calls a cardiologist<br>and sum- marizes the patient&#8217;s symptoms. What portion of HIPAA allows<br>the provider to speak to the cardiologist prior to obtaining the patient&#8217;s<br>consent\u2714\u2714\u2714\u2714 Title II<br>2.A physician is contracted with an insurance company to accept the allowed amount. The insurance company allows $80 of a $120 billed amount,<br>and $50 of the deductible has not been met. How much should the<br>physician write off the patient&#8217;s account\u2714\u2714\u2714\u2714 $40<\/p>\n\n\n\n<ol class=\"wp-block-list\" start=\"3\">\n<li>Which of the following sections of the medical record is used to<br>determine the correct Evaluation and Management code used for billing<br>and coding?-<br>: History and physical<br>4.A billing and coding specialist is reviewing a CMS-1500 claim form. The<br>as- signment of benefits box has been checked yes. The checked box<br>indicates which of the following\u2714\u2714\u2714\u2714 The provider receives payment<br>directly from the payer.<\/li>\n\n\n\n<li>Which of the following do physicians use to electronically submit<br>2 \/ 8<br>claims?-<br>: Clearinghouse<br>6.Which of the following should the billing and coding specialist include in<br>an authorization to release information\u2714\u2714\u2714\u2714 The entity to whom the<br>information is to be released<br>7.Which of the following describes the content of a medical practice<br>aging report\u2714\u2714\u2714\u2714 An overview of the practice&#8217;s outstanding claims<\/li>\n\n\n\n<li>HIPAA transaction standards apply to which of the followingentities\u2714\u2714\u2714\u2714 &#8211;<br>Health care clearinghouses<br>9.When a physician documents a patient&#8217;s response to symptoms and<br>various body systems, the results are documented as which of the<br>follow- ing\u2714\u2714\u2714\u2714 Review of systems<br>10.Which part of Medicare covers prescriptions\u2714\u2714\u2714\u2714 Part D<br>11.Which of the following indicates a claim should be submitted on<br>paper instead of electronically\u2714\u2714\u2714\u2714 The claim requires an<br>attachment.<br>12.Medicare enforces mandatory submission of electronic claims for most<br>providers. Which of the following providers is allowed to submit paper<br>claims to Medicare\u2714\u2714\u2714\u2714 A provider&#8217;s office with fewer than 10 fulltime employees<br>13.Which of the following is the correct term for an amount that has<br>been determined to be uncollectable\u2714\u2714\u2714\u2714 Bad debt<\/li>\n<\/ol>\n\n\n\n<p>1 \/ 9<br>CBCS Final Exam 2022\/2023<br>(Verified Answers by Expert)<br>1.When a billing and coding specialist is completing the CMS-1500<br>claim form, which of the following information is required to process a<br>medical claim\u2714\u2714\u2714\u2714CPT, ICD<\/p>\n\n\n\n<ol class=\"wp-block-list\" start=\"2\">\n<li>The allowed amount for a patient&#8217;s office visit is $175. The copayment is$15 and the amount the insurance paid is $85. Which of the following is the<br>amount of the adjustment\u2714\u2714\u2714\u2714$75<br>3.Which of the following suffixes refers to an abnormal condition\u2714\u2714\u2714\u2714-<br>osis<br>4.Which of the following entities contracts with Medicare to recoup<br>money form inappropriately paid claims\u2714\u2714\u2714\u2714Recovery Audit<br>Contractor<br>5.Which of the following abbreviations is used to describe the reason<br>a patient presents for an encounter at the office visit\u2714\u2714\u2714\u2714CC<br>6.A patient comes in the office with an injury form work. Which box on line<br>1 of the CMS-1500 claim from should the billing and coding specialist<br>check off to transmit the calm for payment\u2714\u2714\u2714\u2714FECA<br>7.Which of the following physical status modifiers should the billing and<\/li>\n<\/ol>\n\n\n\n<p>2 \/ 9<br>coding specialist use to indicate a healthy patient who has no evidence<br>of disease at the time of anesthesia administration\u2714\u2714\u2714\u2714P1<br>8.Which of the following practices does HIPPA Title II define as<br>fraud\u2714\u2714\u2714\u2714Alter- ing codes to increase payment<br>9.A provider charges $30 for a treatment that has an allowed of $25.<br>Which of the following statements regarding this $5 difference between<br>the two amounts is correct\u2714\u2714\u2714\u2714The insurance payer pays the $5 if<br>the provider is a par- ticipating provider.<br>10.A patient who has coinsurance and has met their deductible has<br>which of the following third-party payers\u2714\u2714\u2714\u2714Preferred provider<br>organization(PPO)<br>11.If a patient does not sign box 13 on the CMS-1500 form. Which of<br>the following will receive payment\u2714\u2714\u2714\u2714Provider<br>12.Which is the correct form\u2714\u2714\u2714\u2714Thomas Jr. Martin F<br>13.A patient has a diagnosis of chest pain. The billing and coding<br>specialist should link the diagnosis to the procedure in which of the<br>following blocks on the CMS- 1500 form\u2714\u2714\u2714\u271424D<br>14.A provider&#8217;s office is being investigated for fraud. Which of the<br>following processes will be reviewed first\u2714\u2714\u2714\u2714Compliance Plan<\/p>\n\n\n\n<p>3 \/ 9<br>15.Which of the following entities works with Centers for Medicare and<br>Medicaid services to prevent overpayment\u2714\u2714\u2714\u2714Medicaid Integrity<br>contractors<br>16.Which of the following actions by a billing and coding specialist is<br>insurance abuse\u2714\u2714\u2714\u2714Using a health insurance identification number<br>other than the patients to ensure payments<br>17.Which of the following refers to payers electronically transferring date<br>in order to facilitate coordination of benefits on a clean<br>claim\u2714\u2714\u2714\u2714Crossover<\/p>\n\n\n\n<ol class=\"wp-block-list\" start=\"18\">\n<li>Which of the following is responsible for the health care of its<br>policyhold- ers and identifies health insurance, facilities, providers, or<br>health systems?-<br>: Managed care Organization<br>19.A patient who has TRICARE is seen in the office for a diagnostic test.<br>The test is $500, and the allowable amount is $250. The patient has a 20%<br>cost share, a deductible of $1000, and a catastrophic cap benefit that have<br>all been met. How much should the billing specialist adjust on this<br>visit\u2714\u2714\u2714\u2714$200<br>20.Which of the following is the amount that the patient is financially<br>respon- sible for before the insurance policy provides<br>coverage\u2714\u2714\u2714\u2714Deductible<br>21.The balances listed on an insurance aging report represent which of<br>the following\u2714\u2714\u2714\u2714Outstanding amounts owed to the practice<\/li>\n<\/ol>\n\n\n\n<p>1 \/ 13<br>CBCS Exam Questions &amp; Answers<br>2022\/2023(Verified Answers by Expert)1.What describes the reason for a claim rejection because of Medicare<br>NCCI edits\u2714\u2714\u2714\u2714Improper code combinations<br>2.A claim is submitted with a transposed insurance member ID number<br>and returned to the provider.\u2714\u2714\u2714\u2714Invalid<br>3.Medigap coverage is offered to Medicare beneficiaries by<br>whom\u2714\u2714\u2714\u2714Private third-party payers<br>4.What provision assures that an insured&#8217;s benefits from all insurance<br>com- panies do not exceed 100% of the allowable medical<br>expense\u2714\u2714\u2714\u2714Coordination of benefits<br>5.A coroner&#8217;s autopsy is comprised of what examination\u2714\u2714\u2714\u2714Gross<br>Examination<br>6.What is true regarding the release of a patient records\u2714\u2714\u2714\u2714Patient<br>access to psychotherapy notes is restricted<br>7.What is considered fraud\u2714\u2714\u2714\u2714Billing for services not provided<br>8.What component of an explanation of benefit expedites the process of<br>a phone appeal\u2714\u2714\u2714\u2714Claim control number<\/p>\n\n\n\n<p>2 \/ 13<br>9.On the CMS-1500 claim form, item number 14 &#8211; 33 contain<br>information about\u2714\u2714\u2714\u2714The patient&#8217;s condition and the provider&#8217;s<br>information<br>10.The financial record source that is generated by a provider&#8217;s office<br>is called a\u2714\u2714\u2714\u2714Patients ledger account<br>11.A medical term refers to the sac that encloses the<br>heart\u2714\u2714\u2714\u2714Pericardium<br>12.HIPPA transaction standards apply to which entities\u2714\u2714\u2714\u2714Health care<br>clearing- houses<br>13.All dependents 10 yrs of age or older are required to have what<br>for TRICARE\u2714\u2714\u2714\u2714Military identification<br>14.The standard medical abbreviation &#8221; ECG &#8221; refers to a test used to<br>assess what body system\u2714\u2714\u2714\u2714Cardiovascular system<br>15.Claims that are submitted without an NPI number will delay payment<br>to the provider because\u2714\u2714\u2714\u2714It is used as a preauthorization number<br>16.An example of a violation of patient confidentiality\u2714\u2714\u2714\u2714A billing<br>and coding specialist queries the physician about a diagnosis in a<br>patient&#8217;s medical record<br>17.What section of the medical record is used to determine the correct<br>E&amp;M code used for billing and coding\u2714\u2714\u2714\u2714History and Physical<\/p>\n\n\n\n<p>3 \/ 13<br>18.What action should be taken if an insurance company denies a<br>service as not medically necessary\u2714\u2714\u2714\u2714Appeal the decision with a<br>provider&#8217;s report<br>19.What is the name of the portion of the account balance for which the<br>patient id responsible after service have been rendered and the yearly<br>de- ductible has been met\u2714\u2714\u2714\u2714Coinsurance<br>20.What is the function of the respiratory system\u2714\u2714\u2714\u2714Oxygenating<br>blood cells<br>21.What describes a delinquent claim\u2714\u2714\u2714\u2714The claim is overdue for<br>payment<br>22.What action should taken if he or she observes a colleague in an unethical situation\u2714\u2714\u2714\u2714Report the incident to a supervisor<br>23.A participating Blue Cross\/Blue Shield ( BC\/BS ) provider receives an<br>explanation of benefits for a patient account. The charged amount was<br>$100 BC\/BS allowed $80 and applied $40 to the patient&#8217;s annual deductible.<br>They paid the balance at 80%. How much should the patient expect to<br>pay\u2714\u2714\u2714\u2714$48<br>24.What statement is correct regarding a deductible\u2714\u2714\u2714\u2714The<br>deductible is the patient&#8217;s responsibility<br>25.A physician ordered a comprehensive metabolic panel for a 70-yr old<br>pa- tient who has Medicare as her primary insurance. What forms is<br>required so the patient knows she may be responsible for<br>payment\u2714\u2714\u2714\u2714Advanced Beneficiary Notice<\/p>\n\n\n\n<p>1 \/ 10<br>NHA &#8211; Certified Billing and Coding Specialist (CBCS) Study Guide<br>2022\/2023(Verified Answers by Expert)<br>1.The symbol &#8220;O&#8221; in the Current Procedural Terminology reference is used<br>to indicate what\u2714\u2714\u2714\u2714 Reinstated or recycled code<br>2.In the anesthesia section of the CPT manual, what are considered<br>qualify- ing circumstances\u2714\u2714\u2714\u2714 Add-on codes<br>3.As of April 1, 2014 what is the maximum number of diagnoses that can<br>be reported on the CMS-1500 claim form before a further claim is<br>required\u2714\u2714\u2714\u2714 12<br>4.What is considered proper supportive documentation for reporting CPT<br>and ICD codes for surgical procedures\u2714\u2714\u2714\u2714 Operative report<br>5.What action should be taken first when reviewing a delinquent<br>claim\u2714\u2714\u2714\u2714 Ver- ify the age of the account<\/p>\n\n\n\n<ol class=\"wp-block-list\" start=\"6\">\n<li>A claim can be denied or rejected for which of the following<br>reasons\u2714\u2714\u2714\u2714 &#8211;<br>Block 24D contains the diagnosis code<br>7.A coroner&#8217;s autopsy is comprised of what examinations\u2714\u2714\u2714\u2714 Gross<br>Examina- tion<br>8.Medigap coverage is offered to Medicare beneficiaries by whom\u2714\u2714\u2714\u2714<br>Private third-party payers<br>9.What part of Medicare covers prescriptions\u2714\u2714\u2714\u2714 Part C<\/li>\n<\/ol>\n\n\n\n<p>2 \/ 10<br>10.What plane divides the body into left and right\u2714\u2714\u2714\u2714 Sagittal<br>11.Where can unlisted codes be found in the CPT manual\u2714\u2714\u2714\u2714<br>Guidelines prior to each section<br>12.Ambulatory surgery centers, home health care, and hospice<br>organiza- tions use which form to submit claims\u2714\u2714\u2714\u2714 UB-04 Claim<br>Form<br>13.What color format is acceptable on the CMS-1500 claim form\u2714\u2714\u2714\u2714 Red14.Who is responsible to pay the deductible\u2714\u2714\u2714\u2714 Patient<br>15.A patient&#8217;s health plan is referred to as the &#8220;payer of last resort.&#8221; What<br>is the name of that health plan\u2714\u2714\u2714\u2714 Medicaid<br>16.Informed Consent: Providers explain medical or diagnostic<br>procedures, surgi- cal interventions, and the benefits and risks<br>involved, giving patients an opportunity to ask questions before<br>medical intervention is provided.<br>17.Implied Consent: A patient presents for treatment, such as<br>extending an arm to allow a venipuncture to be performed.<\/p>\n\n\n\n<p>3 \/ 10<br>18.Clearinghouse: Agency that converts claims into standardized<br>electronic for- mat, looks for errors, and formats them according to<br>HIPAA and insurance stan- dards.<br>19.Individually Identifiable: Documents that identify the person or<br>provide enough information so that the person can be identified.<br>20.De-identified Information: Information that does not identify an<br>individual because unique and personal characteristics have been<br>removed.<br>21.Consent: A patient&#8217;s permission evidenced by signature.<br>22.Authorizations: Permission granted by the patient or the patient&#8217;s<br>represen- tative to release information for reasons other than<br>treatment, payment, or health care operations.<br>23.Reimbursement: Payment for services rendered from a third-partypayer.<br>24.Auditing: Review of claims for accuracy and completeness.<br>25.Fraud: Making false statements of representations of material facts<br>to obtain some benefit or payment for which no entitlement would<br>otherwise exist.<br>26.Upcoding: Assigning a diagnosis or procedure code at a higher level<br>than the documentation supports, such as coding bronchitis as<br>pneumonia.<br>27.Unbundling: Using multiple codes that describe different<br>components of a treatment instead of using a single code that<\/p>\n\n\n\n<p>1 \/ 16<br>NHA Billing and Coding Practice Test (CBCS)<br>2022\/2023(Verified Answers by Expert)<br>1.The attending physician\u2714\u2714 A nurse is reviewing a patients lab<br>results prior to discharge and discovers an elevated glucose level.<br>Which of the following health care providers should be altered before<br>the nurse can proceed with discharge planning?<br>2.The patients condition and the providers information\u2714\u2714 On the CMS1500 Claims for, blocks 14 through 33 contain information about which<br>of the following?<br>3.Problem focused examination\u2714\u2714 A provider performs an examination<br>of a pa- tient&#8217;s throat during an office visit. Which of the following<br>describes the level of the examination?<br>4.Reinstated or recycled code\u2714\u2714 The symbol &#8220;O&#8221; in the Current<br>Procedural Ter- minology reference is used to indicate which of the<br>following?<br>5.Coinsurance\u2714\u2714 Which of the following is the portion of the account<br>balance the patient must pay after services are rendered and the<br>annual deductible is met?<br>6.Place of service\u2714\u2714 The billing and coding specialist should divide the<br>evaluation and management code by which of the following?<br>7.Cardiovascular system\u2714\u2714 The standard medical abbreviation &#8220;ECG&#8221;<\/p>\n\n\n\n<p>2 \/ 16<br>refers to a test used to access which of the following body systems?<br>8.add on codes\u2714\u2714 In the anesthesia section of the CPT manual,<br>which of the following are considered qualifying circumstances?<br>9.12\u2714\u2714 As of April 1st 2014, what is the maximum number of<br>diagnosis that can be reported on the CMS-1500 claim form before a<br>further claim is required?<br>10.Nephrolithiasis\u2714\u2714 When submitting a clean claim with a<br>diagnosis of kidney stones, which of the following procedure names<br>is correct?<br>11.Verifying that the medical records and the billing record match\u2714\u2714<br>Which of the following is one of the purposes of an internal auditing<br>program in a physician&#8217;s office?<br>12.The DOB is entered incorrectly\u2714\u2714 Patient Jane Austin; Social<br>Security # 555-22-1111; Medicare ID 555-33-2222A; DOB<br>05\/22\/1945. Claim informa- tion enteredAustin, Jane; Social Security<\/p>\n\n\n\n<h1 class=\"wp-block-heading\">.555-22-1111; Medicare ID No. 555-33-2222A; DOB052245. Which<\/h1>\n\n\n\n<p>of the following is a reason this claim was rejected?<br>13.Operative report\u2714\u2714 Which of the following options is considered<br>proper support- ive documentation for reporting CPT and ICD codes for<br>surgical procedures?<br>14.Verify the age of the account\u2714\u2714 Which of the following actions<br>should be taken first when reviewing delinquent claims?<\/p>\n\n\n\n<p>3 \/ 16<br>15.Claim control number\u2714\u2714 Which of the following components of an<br>explanation of benefits expedites the process of a phone appeal?<br>16.Bloc 24D contains the diagnosis code\u2714\u2714 A claim can be denied or<br>rejected for which of the following reasons?<br>17.Privacy officer\u2714\u2714 To be compliant with HIPAA, which of the<br>following positions should be assigned in each office?<br>18.encrypted\u2714\u2714 All e-mail correspondence to a third party payer<br>containing pa- tients&#8217; protected health information (PHI) should be<br>19.patient ledger account\u2714\u2714 A billing and coding specialist should<br>understand that the financial record source that is generated by a<br>provider&#8217;s office is called a<br>20.Coding compliance plan\u2714\u2714 Which of the following includes<br>procedures and best practices for correct coding?<br>21.Health care clearinghouses\u2714\u2714 HIPAA transaction standards apply to<br>which of the following entities?<br>22.Appeal the decision with a provider&#8217;s report\u2714\u2714 Which of the following<br>actions should be taken if an insurance company denies a service as<br>not medically necessary?<br>23.Accommodate the request and send the records\u2714\u2714 A patient with a<br>past due balance requests that his records be sent to another<br>provider. Which of the following actions should be taken?<br>24.$48\u2714\u2714 A participating BlueCross\/ BlueShield (BC\/BS) provider<br>receives an ex- planation of benefits for a patient account. The<\/p>\n\n\n\n<p>4 \/ 16<br>charged amount was $100. BC\/BS allowed $40 to the patients annual<br>deductible. BC\/BS paid the balance at 80%. How much should the<br>patient expect to pay?<br>25.Deductible\u2714\u2714 The physician bills $500 to a patient. After submitting<br>the claim to the insurance company, the claim is sent back with no<br>payment. The patient still owes $500 for this year.<br>26.International Classification of Disease (ICD)\u2714\u2714 Which of the following<br>is used to code diseases, injuries, impairments, and other health<br>related problems?<br>27.Ureters\u2714\u2714 Urine moves from the kidneys to the bladder through<br>which of the following parts of the body?<br>28.Angioplasty\u2714\u2714 Threading a catheter with a balloon into a coronary<br>artery and expanding it to repair arteries describes which of the<br>following procedures?<\/p>\n","protected":false},"excerpt":{"rendered":"<p>1 \/ 10NHA- CBCS EXAM REVIEW2022\/2023(Verified Answers by Expert)1.UROLOGIST\u2714\u2714 A would be theprovider who would perform an orchiopexy2.EVALUATION AND MANAGEMENT CODES\u2714\u2714 The first section ofthe CPT manual is the .3.ALLOWED AMOUNT\u2714\u2714 means theamount of reimbursement an insurance payer and patient agrees topay a provider.4.PLACE OF SERVICE\u2714\u2714 A billing and coding specialist shoulddetermine first, theto determine 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