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(Answered)Certification study guide for NHA CBCS Exam 2023., Exams of Nursing

Ulster UniversityNursing

(Answered)Certification study guide for NHA CBCS Exam 2023.

Typology: Exams

2023/2024

Available from 07/09/2024

EXAMSPLUGLINE
EXAMSPLUGLINE 🇬🇧

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(Answered)Certification study guide for
NHA CBCS Exam 2023
Medical Ethics - Answer Standards of conduct based on moral principals. Acting
within ethical behavior boundries means carrying out one's responsibilities with
integrity, decency, respect, honesty, competence, fairness and trust.
Compliance Regulations - Answer Most billing related cases are based on HIPAA
and the False Claims Act.
HIPAA is an acronym for - Answer Health Insurance Portability and Accountability
Act of 1996.
Category 1 CPT codes - Answer Medical Procedures.
Category 2 CPT codes - Answer Supplemental Codes for Performance Measures.
Category 3 CPT codes - Answer Emerging Technologies.
Add on Codes - Answer Used for procedures that are always performed during the
same operative session, as another surgery in addition to the primary
service/procedure and is never performed separately.
Anesthesia is found - Answer 00100-01999, 99100-99140.
Evaluation and Management (E&M) codes - Answer Are listed first in the CPT
manual because they are used by all the different specialties.
Brackets - Answer Used to enclose synonyms, alternative wording or and
explanatory phrase.
Bullets - Answer Represents a new procedure or service code added since the
previous edition of the manual.
Chief Complaint (CC) - Answer The reason the patient came to see the physician.
Circle with a line through it (🚫) - Answer Exemption from modifier 51.
CPT - Answer Used to report services and procedures by physicians.
E&M codes - Answer 99201-99499
Guidelines are found - Answer At the beginning of each section and used to provide
specific coding rules for that section.
History (HX) - Answer The set of information the physician gathers from the patient
concerning his/her past.
History of Present Illness (HPI) - Answer A chronological account of the development
of the complaint from the first sign or symptom that the patient experienced to the
present.
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NHA CBCS Exam 2023

Medical Ethics - Answer Standards of conduct based on moral principals. Acting within ethical behavior boundries means carrying out one's responsibilities with integrity, decency, respect, honesty, competence, fairness and trust. Compliance Regulations - Answer Most billing related cases are based on HIPAA and the False Claims Act. HIPAA is an acronym for - Answer Health Insurance Portability and Accountability Act of 1996. Category 1 CPT codes - Answer Medical Procedures. Category 2 CPT codes - Answer Supplemental Codes for Performance Measures. Category 3 CPT codes - Answer Emerging Technologies. Add on Codes - Answer Used for procedures that are always performed during the same operative session, as another surgery in addition to the primary service/procedure and is never performed separately. Anesthesia is found - Answer 00100-01999, 99100-99140. Evaluation and Management (E&M) codes - Answer Are listed first in the CPT manual because they are used by all the different specialties. Brackets - Answer Used to enclose synonyms, alternative wording or and explanatory phrase. Bullets - Answer Represents a new procedure or service code added since the previous edition of the manual. Chief Complaint (CC) - Answer The reason the patient came to see the physician. Circle with a line through it (🚫) - Answer Exemption from modifier 51. CPT - Answer Used to report services and procedures by physicians. E&M codes - Answer 99201- Guidelines are found - Answer At the beginning of each section and used to provide specific coding rules for that section. History (HX) - Answer The set of information the physician gathers from the patient concerning his/her past. History of Present Illness (HPI) - Answer A chronological account of the development of the complaint from the first sign or symptom that the patient experienced to the present.

NHA CBCS Exam 2023

Indented Codes - Answer Listed under associate and stand alone codes. E Codes - Answer For durable medical equipment for use in home. Level 1 codes - Answer Codes found in the CPT manual. Level 2 codes - Answer National codes for the physician and non-physician service not found in the CPT Level 1. Level 3 codes - Answer Used locally or regionally and have been eliminated by the CMS since the implementation of HIPAA. The List of Modifiers is found where in the CPT - Answer Appendix A and in the front of the book. Modifier 50 - Answer Bilateral procedure. Modifier 24 - Answer Attach to E/M service code when service is provided during postoperative period to indicate that the service is not part of postoperative care and not included in the Surgical Package. Modifier 26 - Answer Provider only provided the professional component. Modifier 51 - Answer Used more than one procedure during the same surgical episode. Modifier 57 - Answer Modifier 57 is used on E/M services the day before or day of major surgery when the initial decision to perform the surgery is identified. Modifier 78 - Answer Physician must return to Operating Room to address complication stemming from initial procedure. Modifier 79 - Answer Procedure or service provided during postoperative period not associated with initial procedure. Modifiers - Answer Reporting indicators that indicate that the procedure or service has been altered by specific circumstance but has not changed in it's definition of code. Parentheses - Answer Used to enclose supplementary words, non-essential modifiers. Past, Family and Social History (PFSH) - Answer Consists of patients personal experiences with illnesses, surgeries, and injuries; Information of illnesses predominant in family' Patients educational background, occupation, marital status and other factors.

NHA CBCS Exam 2023

Medicaid categorically needy - Answer A distinction for individuals who fall into a specific category (or criteria) of mandatory Medicaid eligibility established by the federal government. These categories apply to every state Medicaid program. Medicaid Medically Needy - Answer Provide Medicaid to certain groups not otherwise eligible for Medicaid, must cover: ▪Pregnant women ▪Children under 18: States have option to cover: ▪Children up to 21 ▪ Parents and other caretaker relatives ▪ Elderly ▪ Individuals with disabilities. Who is the Payer of Last Resort - Answer Medicaid is always the payer of last resort. Tricare - Answer Health care program for Uniformed Service members, retirees and their families. Tricare Standard - Answer Option that provides the most flexibility to TRICARE- eligible beneficiaries. It is the fee-for-service option that gives beneficiaries the opportunities to see any TRICARE-authorized provider. Tricare Extra (PPO) - Answer A preferred provider option, rather than an annual fee, a yearly deductible is charged. Health care is delivered through a network of civilian health care providers who accept payments from CHAMPUS and provide services at negotiated, discounted rates. Tricare Prime (HMO) - Answer An HMO type plan in which enrollees receive health care through a Military Treatment Facilities PCM or a supporting network of civilian providers. CHAMPVA - Answer Comprehensive health care program in which the VA shares the cost of covered health care services and supplies with eligible beneficiaries. Private payer vs Commercial payer - Answer Private individuals are responsible for securing their own health insurance coverage. Commercial Government, Employer, Group health insurance coverage. Group Health Plans - Answer An insurance plan that provides healthcare coverage to a select group of people. Group health insurance plans are one of the benefits offered by many employers. These are generally uniform in nature, offering the same benefits to all members of group. Indemnity Insurance - Answer Health indemnity insurance is a fee for service insurance that is sometimes used when a person is in between health plans, and will cover some (but not all) expenses. HMO - Answer Health Maintenance Organization. A form of health insurance combining a range of coverages in a group basis. A group of doctors and other medical professionals offer care through the HMO for a flat monthly rate with no deductibles.

NHA CBCS Exam 2023

PPO - Answer PPO is similar to an HMO, but care is paid for as received instead of in advance in form of a schedule. PPOs may offer more flexibility by allowing for visits to out-of-network professionals. Visits within network require only the payment of a small fee. Point of Service - Answer Feature of an insurance plan that allows a patient to choose between in-network care and out-of-network care every time he or she sees a doctor. The patient is allowed the freedom to go to whichever doctor is most convenient, although the cost will vary. Disability Insurance - Answer Policyholder becomes incapable of working. Workman's Comp - Answer Workman's compensation is a job benefit that provides money and services to employees that are injured or become sick on the job. Woker's comp helps injured and sick workers to survive financially as they recover from health problems. Usual Customary and Reasonable - Answer Refer to the base amount that is treated as the standard or most common charge for a particular medical service when rendered in a particular geographic area. Relative Value Payment Method - Answer The payment amount for each service paid under the physician fee schedule is the product of three factors; a nationally uniform relative value for service; a geographic adjustment factor (GAF); a nationally uniform conversion factor for the service. Medicare Resource Based Relative Value Unit (RVU) Payments/Components - Answer The schedule assigns certain values to procedures/costs based upon Total RVUs. The total consists of three components; work, practice expense, and malpractice. Medicare adjusts payment by geographic price cost index (GPCI) and pays depending on locale. Clean Claim - Answer A completed insurance claim form submitted with the program time limit that contains all the necessary information without deficiencies so it can be processed and paid promptly. Dirty Claim - Answer A claim submitted with errors or one that requires manual processing to resolve problems or is rejected for payment. Invalid Claim - Answer Any Medicare claim that contains complete, necessary information but is illogical or incorrect (e.g., listing an incorrect provider member for a referring physician). Invalid claims re identified to the provider and may be resubmitted. Rejected Claim - Answer A rejected claim is an electronically submitted claim that is unprocessable due to missing or invalid information required by the payer.

NHA CBCS Exam 2023

Hypertension, Neoplasm, and Table of Drugs and Chemicals - Answer What are the names of the three tables that appear in the Index to Diseases? Remittance Advice - Answer The explanation of payments received from the insurance company is often referred to or called the ______________. Balance Billing - Answer Billing a patient for the difference between a higher usual fee and a lower allowed charge is called ______________. Medicare - Answer ___________ is the national health insurance program for Americans aged 65 and older. Medicaid "payer of last resort" - Answer A health-benefit program designed for low- income, blind, or disabled patients; needy families; foster children; and children born with birth defects. What is the single largest healthcare program in the United States? - Answer Medicare Affordable Care Act (ACA) - Answer Signed into law in 2010, an act that resulted in improved access to affordable healthcare coverage and protection from abusive practices by healthcare insurance companies is what? Guarantor - Answer Person who is responsible for a patients debt is called? Medigap - Answer Medicare beneficiaries can also obtain supplemental insurance called what? What does Medigap do? - Answer Helps cover costs not reimbursed by the original Medicare plan. Subpoena - Answer A writ requiring the appearance of a person at a trial or other proceeding is a _______. When does the tertiary insurance pay? - Answer After the primary and secondary insurers. Health Common Procedure Coding System (HCPCS) - Answer A numeric and alphabetic coding system used for billing/pricing of procedures, medical supplies, medications, and durable medical equipment (DME). Preferred Provider Organization (PPO) - Answer A managed care organization that establishes a network of providers who care for their patients is called a/an ___________. Clearinghouse - Answer A group that takes nonstandard medical billing software formats and translates them into the standard Electronic Data Interchange (EDI) formats is called a/an?

NHA CBCS Exam 2023

Deductible - Answer The out-of-pocket payment amount that a policyholder must meet before insurance covers the service(s) is called? National Provider Identifier (NPI) number - Answer A unique 10-digit number assigned to providers in the U.S. to identify themselves in all HIPAA transactions. What is a capitation? - Answer A payment structure in which a health maintenance organization prepares an annual set fee per patient to a physician. Copayment - Answer A fixed fee collected at the time of the patient's visit. Coinsurance - Answer A fixed percentage of covered charges applied to the patients bill after the deductible has been met. Premium - Answer The charge for keeping the insurance policy in effect. Abuse - Answer Coding and billing that is inconsistent with typical coding and billing practices. How does HIPAA define fraud? - Answer An intentional deception of misrepresentation. Intent - Answer "The difference between fraud and abuse is ________." Current Procedural Terminology (CPT) codes - Answer Numeric codes developed by the American Medical Association (AMA) to standardize medical services and procedures. Is abuse intentional? - Answer No Roster Billing - Answer What simplified process was developed to enable Medicare beneficiaries to participate in mass pneumococcal pneumonia virus (PPV) and influenza virus vaccination programs offered by public health clinics. Claimant - Answer A person filing an appeal is called? Liability Insurance - Answer Covers injuries caused by insured that occurred on the insured's property. Remittance Advice (RA) - Answer A detailed accounting of the claims for which payment is being made by an insurance company. The ______ accompanies the payment from the insurance company. Assignment of Benefits - Answer Authorization by a policyholder that allows a payer to pay benefits directly to a provider is called?

NHA CBCS Exam 2023

Confidential - Answer Everything a medical claims specialist learns about a patient's condition must remain.