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CBCS NHA PRACTICE TEST
2024/2025 GRADED A+
"Which of the following statements is correct regarding a deductible? -Coinsurance is a type of deductible -The physician should write off the deductible -The insurance company pays for the deductible
-The deductible is the patient's responsibility - CORRECT ANSWER The deductible is the
patient's responsibility" "Which of the following color formats allows optical scanning of the CMS-1500 claim form? -Red -Blue -Green
-black - CORRECT ANSWER red"
"Ambulatory surgery centers, home health and hospice organizations use the ______. -CMS-1500 claim form -UB-04 claim form -Advance Beneficiary notice
-First report of injury form - CORRECT ANSWER UB-04"
"Claims that are submitted without an NPI number will delay payment to the provider because ______. -The number is the patient' id number -The number is needed to identify the provider -Is is used as a claim number
-It is used as a pre authorization number - CORRECT ANSWER The number is needed to
identify the provider" "Which of the following terms describes when a plan pays 70% of the allowed amount and the patient pays 30%? -Coinsurance -Deductible -Premium
-copayment - CORRECT ANSWER coinsurance"
"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? -Provider -Insurance company -Patient
-Third party payer - CORRECT ANSWER provider"
"A physician is contracted with an insurance company to accept the amount. The insurance company allows $80 of a $120 billed amount, and $50 of the deductible has not been met. How much should the physician write off the patient's account? -$ -$ -$
-$50 - CORRECT ANSWER $40"
"The unlisted codes can be found in which of the following locations in the CPT manual? -Appendix L -Guidelines prior to each section -End of each body system
-Table of contents - CORRECT ANSWER Guidelines prior to each section"
"Which of the following blocks should the billing and coding specialist complete the CMS 1500 claims form for procedure, services or supplies? -Block 12 -Block 2 -Block 24D
-Block 24J - CORRECT ANSWER Block 24D
-Block 12 (patient's authorization block -Block 2 ( patient's name) -Block 24J ( for the rendering provider)" "Which of the following blocks requires the patient's authorization to release medical information to process a claim? Block 12 Block 13 Block 27
Block 31 - CORRECT ANSWER Block 12
- Block 13 patient authorization for benefits required for third party payer
-Internal monitoring and auditing -Utilization review
-Correct coding initiative - CORRECT ANSWER Internal monitoring and auditing"
"In an outpatient setting, which of the following forms is used as a financial report of all services provided to patients? -Encounter form -Patient account record -CMS-1500 claim form
-Accounts receivable journal - CORRECT ANSWER Patient account record (patient ledger, all
transactions between patient and the practice) -Accounts receivable journal (Day sheet = chronological summary of all transaction on a specific day)" "Patient charges that have not been paid will appear in which of the following? -Accounts receivable -Accounts payable -Tracer
-Rejected claim - CORRECT ANSWER Accounts receivable"
"Which of the following is considered the final determination of the issues involving settlement of an insurance claim? -Processing -Translation -Adjudication
-Transmission - CORRECT ANSWER Adjudication (process of putting a claim through a series of
edits for final determination) -Processing ( handling a claim from the first encounter to claim submission) -Translation (claim is send from the host system to the clearing house) -Transmission (how the claim was sent)" "Which of the following information should the CBCS input into block 33a on the CMS-1500 claim form -Provider social security number (no Social security number on CMS1500) -Federal tax id number (entered in block 25) -Patient id number (on block 1a)
-National provider identification number - CORRECT ANSWER National provider identification
number"
"A prospective billing account audit prevents fraud by reviewing and comparing a completed claim form with which of the following documents? -A billing worksheet from the patient account -A superbill -A day sheet
-Am accounts receivable report of the patient account - CORRECT ANSWER A billing
worksheet from the patient account" "When a patient has a condition that is both acute and chronic, how should it be reported? -Code only the acute code -Code both acute and chronic, sequencing the acute first -Code only the chronic code
-Code both acute and chronic, sequencing the chronic first - CORRECT ANSWER Code both
acute and chronic, sequencing the acute first" "Accepting assignment on the CMS-1500 claim form indicates which of the following? -The patient agrees to accept payment and forward the payment to the physician -The physician agrees to accept payment under the terms of the payer's program. -The physician agrees to bill according the third payer's fee schedule
-The patient agrees to pay the difference between the billed amount and the allowed amount -
CORRECT ANSWER The physician agrees to accept payment under the terms of the payer's
program." "Which of the following sections of the medical record is used to determine the correct evaluation and management code to use for billing and coding? -Codes used during prior patient visits -Patient's insurance plan -Plan of care
-History and physical - CORRECT ANSWER History and physical"
"A patient has met a Medicare deductible of $150. The patient's coinsurance is 20%, and the allowed amount is $600. Which of the following is the patient's out of pocket expense? -$ -$ -$
-$150 - CORRECT ANSWER $120"
"Which of the following is allowed when billing procedure codes?
-17a
-21 - CORRECT ANSWER 21
-24D (CPT or HCPCS codes) -22 (resubmitting to Medicare) -17a not required" "A participating blue cross/blue shield provider receives an explanation of benefits for a patient account. The charged amount was $100. Blue shield allowed $80 and applied $40 to the patient's annual deduction. Blue shield paid the balance at 80%. How much should the patient expect to pay? -$ -$ -$
-$48 - CORRECT ANSWER $48"
"A biller will electronically submit a claim to the carrier via which of the following? -Electronic remittance advice (response from insurance) -Direct data entry -Electronic fund transfer
-Charge data entry - CORRECT ANSWER Direct data entry"
"What is the maximum number of ICD codes that can be entered on a CMS-1500 claim form as of February 2012? 4 6 10
12 - CORRECT ANSWER 12"
"Test results indicated that abnormalities were found in the brain's brain electrical activity patterns are normal. Which of the following tests was used to conduct the exam? -EEG -ECT -EMG
-EGD - CORRECT ANSWER EEG
-ECT (electroconvulsive therapy - to treat major depression that does not respond to standard treatment) -EMG (electromyography = test and recording the electrical activity produced skeletal muscles)
-EGD (esophagogastroduodenoscopy = test that examines the lining of the esophagus, stomach and upper part of the small intestine)" "The destruction of lesions using cryosurgery would use which of the following treatments? -Laser treatment -Chemical peel treatment -Cold treatment
-Electric current treatment - CORRECT ANSWER Cold treatment"
"On the CMS-1500 claim form, block 1 through 13 include which of the following? -The patient's demographics -The provider's information -The patient's diagnosis
-The procedures performed - CORRECT ANSWER The patient's demographics
-The provider's information (on blocks 25-33) -The patient's diagnosis (block 21) -The procedures performed (block 24)" "Which of the following is the appropriate diagnosis for a patient who has an abnormal accumulation of fluids in her lower leg that has resulted in swelling? -Ptosis (drooping) -Emesis (vomiting) -Edema
-Dilation (widening) - CORRECT ANSWER edema
-Ptosis (drooping) -Emesis (vomiting) -Dilation (widening)" "Which of the following security features is required during transmission of protected health information and medical claims to third party payers? -Unique used IDs and passwords -Role based access controls -Electronic data interchange
-Encryption - CORRECT ANSWER encryption"
"Which of the following actions should the CBCS take to effectively manage accounts receivable? -Collect payment from the patient at the time of service -Have the patient pat the balance up front and wait for reimbursement
"Which of the following situations constitutes a consultation?
- Services rendered by a physician whose opinion or advice is required by another physician or agency.
- The physician needs to meet the family and the patient to discuss the medical condition
- The transfer of the total or specific care of a patient from one physician to another for known problem
- The physician has had the initial treatment and needs to follow-up with the patient regarding
the care plan - CORRECT ANSWER Services rendered by a physician whose opinion or advice is
required by another physician or agency." "Which of the following billing patterns is the best practice action?
- Billing for diagnostic tests without a separate report in patient's health record
- Billing the patient for the difference between the charges and the allowed amounts
- Documenting the patient's chief complaint, history, exam, assessment, and plan for care
- Separating service or procedure codes to increase reimbursement - CORRECT ANSWER Documenting the patient's chief complaint, history, exam, assessment, and plan for care" "When billing a secondary insurance, which block should the CBCS fill out on the CMS-1500 form? 9a 28 24J
24F - CORRECT ANSWER 9a
- 28 (total billed amount)
- 24J (NPI)
- 24F (charge per service)" "Which of the following describes an obstruction of the urethra? -Urethralgia (pain) -Urethratresia -Urethrism (stricture)
-Uretritis - CORRECT ANSWER Urethratresia
-Urethralgia (pain) -Urethrism (stricture)" "Which of the following is the correct entry of a charge of $150 in block 24F? 150 00 150
15000 - CORRECT ANSWER 150 00"
"Which of the following organizations identifies improper payments made on CMS claims?
- Office of inspector general (OIG)
- Quality improvement organization (QIOs)
- Recovery audit contractor (RAC)
- Medicare administrative Contractors (MACs) - CORRECT ANSWER Recovery audit contractor (RAC)
- Office of inspector general (OIG) (protect the integrity of the department of Health and Human services programs)
- Quality improvement organization (QIOs) (perform utilization and quality control review of healthcare furnished to Medicare beneficiaries
- Medicare administrative Contractors (MACs)" "When coding on the UB-04 form, the CBCS must sequence the diagnosis codes according to ICD guidelines. Which of the following is the first listed diagnosis code?
- Primary diagnosis
- Chief complaint
- Etiology (underlying cause of the disease)
- Principal diagnosis - CORRECT ANSWER Principal diagnosis" "A provider performs an examination of a patient's sore throat. Which of the following describes the level of the examination?
- Expanded problem focused examination
- Detailed examination
- Problem focused examination
- Comprehensive examination - CORRECT ANSWER Problem focused examination
- Expanded problem focused examination ( specific examination of an affected organ system and related organ systems)
- Detailed examination (extended examination of an affected organ system, and other related organ systems
- Comprehensive examination (general multi system examination)" "Which of the following coding manuals is used to identify products, supplies and services?
- ICD-10 manual (diagnosis codes)
- HCPCS level II manual
- ICD-10-PCS manual (inpatient facilities to assign procedures)
- CPT manual (outpatient professional service and procedure codes in an - CORRECT ANSWER HCPCS level II manual
- ICD-10 manual (diagnosis codes)
-53 (physician uses this for a procedure begun but discontinued prior to its completion) -
CORRECT ANSWER 53 (physician uses this for a procedure begun but discontinued prior to its
completion)
- 73 (used by facilities to indicate a discontinued outpatient procedure prior to procedure) -52 ( physician to indicate that a service code was reduced from its original description) -74 ( facilities to indicate a discontinued outpatient procedure after the procedure)" "Which of the following is used by providers to remove errors from claims before they are submitted to third party payers?
- National committee for quality assurance
- HIPAA transaction and code sets (TCS)
- Correct coding initiative (CCI)
- clearinghouse - CORRECT ANSWER clearinghouse
- National committee for quality assurance (report standards that compare performance between health care plans)
- HIPAA transaction and code sets (TCS) (standardizes electronic claim transactions)
- Correct coding initiative (CCI) ( prevents unbundling)" "Block 17b should list which of the following information?
- Referring physician's national provider identification number
- Referring physicians name
- Rendering physician's national provider identification number
- Rendering physician's name - CORRECT ANSWER Referring physician's national provider identification number
- Referring physicians name (block 31)
- Rendering physician's national provider identification number (24i)
- Rendering physician's name (17)" "Which of the following is the third stage of the life cycle of a claim?
- Claim processing
- Claims payment
- Claims adjudication
- Claims submission - CORRECT ANSWER Claims adjudication
- Claim processing (second)
- Claims payment ( fourth)
- Claims submission (first)" "A patient presents to the provider with chest pain and shortness of breath. 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?
- Title I
- The privacy rule
- Title II
- FERPA - CORRECT ANSWER Title II
- Title I (regulates insurance reform)
- The privacy rule
- FERPA ( family education right and privacy act = protects the privacy of student records, not part of HIPAA)" "Which of the following statements is true regarding the release of patient records?
- Verbal requests for records from life insurance companies are appropriate
- Identification is not required when requesting access to patient records
- Providers cannot share a patient' medical information with other health care professionals if the patient's mentally unstable
- Patient access to psychotherapy notes may be restricted - CORRECT ANSWER Patient access to psychotherapy notes may be restricted" "A claim is denied because the service was not covered by the insurance. Upon confirmation of no errors on the claim, which of the following describes the process that will follow the denial?
- The claim will be submitted with a new CPT code
- The claim will not be resubmitted and the patient will be sent a bill
- The claim will be resubmitted with a modifier on the CPT code
- The claim will not be resubmitted, but the claim will be appealed. - CORRECT ANSWER The claim will not be resubmitted and the patient will be sent a bill" "When an electronic claim is rejected due to incomplete information, which of the following action should the CBCS take?
- Process the claim as an adjustment
- Complete the information and retransmit according to the third party standards
- Reprocess the rejected claim within 30 days
- Send the claim back with the next batch of claims - CORRECT ANSWER Complete the information and retransmit according to the third party standards" "In 1995 and 1997 , which of the following introduced documentation guidelines to Medicare carriers to ensure that service paid for have been provided and were medically necessary?
- HIPAA
- NPI - CORRECT ANSWER NCCi (national correct coding initiative - detect inappropriate codes and eliminate improper coding practices)
- HIPAA
- MAC (Medicare administrative contractor)
- NPI" "After a third party validates a claim, which of the following takes place next?
- Claim payment
- Claim adjudication (process of analyzing the claim)
- Claim resolution (small claims court)
- Claim attachment - CORRECT ANSWER Claim adjudication (process of analyzing the claim)
- Claim payment
- Claim resolution (small claims court)
- Claim attachment" "A CBCS is reviewing a CMS-1500 claim form. The assignment of the benefits box has been checked "yes". The check box indicates which of the following?
- The provider receives payment directly from payer
- The payer sends reimbursement for service to the patient
- The payer pays the provider a set amount for each enrolled person assignment of benefit box
- The provider can collect full payment from the patient - CORRECT ANSWER The provider receives payment directly from payer" "Which of the following is the primary information used to determine the priority of collection letters to patients?
- The age of the account
- The type of the account
- The type of the insurance
- The last payment received - CORRECT ANSWER the age of the account" "Which of the following claims would appear on an aging report?
- A claim paid in full within the past 90 days
- A claim that is delinquent for 60 days
- A claim processed and paid within past 60 days
- A claim that billed and reimbursed the patient within the past 30 days - CORRECT ANSWER A claim that is delinquent for 60 days"
"A CBCS should enter the prior authorization number on the CMS-1500 claim form in which of the following blocks?
- 21A (diagnosis code)
- 24 D (procedures and services)
- 23 (prior authorization)
- 24E (federal tax id) - CORRECT ANSWER 23 (prior authorization)
- 21A (diagnosis code)
- 24 D (procedures and services)
- 24E (federal tax id)" "Which of the following blocks require the patient's authorization to release medical information to process a claim?
- 12
- 13 (patient authorization for assignment of benefits required for third party payer
- 27 (accepting assignment of benefits)
- 31 (treating physician's name) - CORRECT ANSWER 12
- 13 (patient authorization for assignment of benefits required for third party payer
- 27 (accepting assignment of benefits)
- 31 (treating physician's name)" "Which of the following actions by a CBCS would be considered fraud?
- Submitting a claim for services that are not medically necessary
- Violating participating provider agreements with third party payer
- Billing for services not provided
- Billing non-covered services as covered services - CORRECT ANSWER billing for services not provided" "Which of the following privacy measures ensures PHI?
- Confirming test results with the patient over the phone at the reception
- Asking patients the reason for their visit at check in
- Using data encryption software on office workstation
- Calling a patient into the clinical area using first and last name. - CORRECT ANSWER Using data encryption software on office workstation" "A form that contains charges, DOS, CPT codes, ICD codes, fees and copayment information is called which of the following?
- Encounter form
- Itemized bill
- Chargemaster
"Which of the following forms should the CBCS transmit to the insurance carrier for reimbursement of inpatient hospital services?
- UB-02 (obsolete version of UB-04)
- UB-
- HCFA-1500 ( obsolete version of CMS 1500)
- CMS-1500 - CORRECT ANSWER UB-04" "Which of the following information should the CBCS input into block 33a? -Provider social security number -Federal tax ID number (25) -Patient's ID number (1a)
-NPI - CORRECT ANSWER NPI
- Provider social security number -Federal tax ID number (25) -Patient's ID number (1a)Which of the following is a private insurance carrier?" "Which of the following is a private insurance carrier? Medicare Medicaid TRICARE
Blue cross/shield - CORRECT ANSWER blue cross/shield"
"Which of the following sections of the medical record is used to determine the correct evaluation and management code for billing and coding? -Codes used during prior patient visit -Patient's insurance plan -Plan of care
-History and physical - CORRECT ANSWER History ad physicals"
"Which of the following describes the reason for a claim rejection because of Medicare NCCI edits?
- Reporting codes without proper modifiers
- Coding without proper documentation
- Medicare NCCI edit will trigger a claim rejection for improper code combination
- Use of outside codes - CORRECT ANSWER Medicare NCCI edit will trigger a claim rejection for improper code combination" "Which of the following departments should a patient be seen for psoriasis?
- Cardiologist
- Dermatologist
- Otolaryngology
- gastroenterology - CORRECT ANSWER dermatologist" "A nurse is reviewing a patient's lab results prior to discharge and discovers an elevated glucose level. Which of the following health care providers should be alerted before the nurse can proceed with discharge planning?
- The attending physician
- The admitting physician
- The nursing supervisor
- The physician assistant - CORRECT ANSWER attending physician" "On the CMS-1500 claim form, blocks 14 to 33 contain information about which of the following?
- Patient demographics
- The patient's condition and the provider's information
- The insurance name and address
- The patient's medical history - CORRECT ANSWER - The patient's condition and the provider's information" "The star symbol in the CPT code book is used to indicate which of the following?
- New code
- Exempt from the used of modifier 51
- Revised code
- telemedicine - CORRECT ANSWER telemedicine
- New code (bullet or dot symbol)
- Exempt from the used of modifier 51 (circle with line through it)
- Revised code (blue triangle)" "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? Coinsurance Allowed amount Premium
capitation - CORRECT ANSWER &"
"The CBCS should first divide the evaluation and management code by which of the following?
- Place of service
- Severity
- Combination code (diagnosis)
- Point of service (type of insurance) - CORRECT ANSWER place of service"
