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CBCS PRACTICE FOR NHA
QUESTIONS WITH CORRECT ANSWERS
2024/2025 GRADED A+
"Operative Report - CORRECT ANSWER What is considered proper supportive documentation
for reporting CPT and ICD codes for surgical procedures?"
"Guidelines prior to each section - CORRECT ANSWER Where can unlisted codes be found in
the CPT manual."
"17b - CORRECT ANSWER Where does the NPI number go on the CMS-1500 form?"
"Electronic Data Interchange - CORRECT ANSWER The transfer of electronic information in a
standard form."
"Explanation of Benefits (EOB) - CORRECT ANSWER Describes the services rendered, payment
covered, and benefit limits and denials."
"Medicare Part A - CORRECT ANSWER Provides hospitalization insurance to eligible
individuals."
"Medicare Part B - CORRECT ANSWER Voluntary supplemental medical insurance to help pay
for physicians' and other medical professionals' services, medical services, and medical-surgical supplies not covered by Medicare Part A."
"Medicare Advantage (MA) - CORRECT ANSWER Combined package of benefits under
Medicare Parts A and B that may offer extra coverage for services such as vision, hearing, dental, health and wellness, or prescription drug coverage."
"Medicare Part D - CORRECT ANSWER prescription drug coverage by Medicare"
"Medigap - CORRECT ANSWER A private health insurance that pays for most of the charges
not covered by Medicare Parts A and B."
"Who is usually the Gatekeeper? - CORRECT ANSWER The primary physician."
"Formulary - CORRECT ANSWER A list of prescription drugs covered by an insurance plan."
"Tier 1 - CORRECT ANSWER Providers and facilities in a PPO's network."
"Tier 2 - CORRECT ANSWER Providers and facilities within a broader, contracted network of
the insurance company."
"Tier 3 - CORRECT ANSWER Providers and facilities out of the network."
"Tier 4 - CORRECT ANSWER Providers and facilities not on the formulary."
"Preferred Provider - CORRECT ANSWER Tier 2 provider"
"Charge Description Master (CDM) - CORRECT ANSWER Information about health care
services that patients have received and financial transactions that have taken place."
"E Codes - CORRECT ANSWER Codes used to classify environmental events, circumstances,
and conditions, such as the cause of injury, poisoning, and other adverse events."
"Category 1 CPT Code - CORRECT ANSWER Code that covers physicians' services and hospital
outpatient coding."
"Category 2 CPT Code - CORRECT ANSWER Code designed to serve as supplemental tracking
codes that can be used for performance measurement."
"Category 3 CPT Code - CORRECT ANSWER Code used for temporary coding for new
technology and services that have not met the requirements needed to be added to the main section of the CPT book."
"Abstracting - CORRECT ANSWER The extraction of specific data from a medical record, often
for use in an external database, such as a cancer registry."
"APC Grouper - CORRECT ANSWER Helps coders determine the appropriate ambulatory
payment classification (APC) for an outpatient encounter."
"HCPS - CORRECT ANSWER A coding book that contains codes for medical products and
supplies."
"Non-Availability Statement (NAS) - CORRECT ANSWER form required when a TRICARE
member seeks medical services outside an military treatment facility."
"DRGs (diagnosis-related groups) - CORRECT ANSWER Individuals with similar diagnosis and
determining needs."
"HPI, PI - CORRECT ANSWER History of present illness, present illness."
"AMA (American Medical Association) - CORRECT ANSWER Responsible for updating HCPCS
and CPT changes."
"Disclosure - CORRECT ANSWER Releasing, giving access to, or transferring PHI to an outside
person or organization."
"Arthroscopy - CORRECT ANSWER An examination of a knee joint via small incision and optical
device."
"Gastropexy - CORRECT ANSWER Surgical fixation of the stomach to the abdominal wall for
correction of displacement."
"HIPAA Security Rule - CORRECT ANSWER Protects the confidentiality, integrity, and
availability of electronic health information."
"UB-04 form - CORRECT ANSWER Used for billing hospital services."
"Role-Based Access - CORRECT ANSWER Access is based on the role a person plays in an
organization."
"Dirty Claim - CORRECT ANSWER An insurance claim that is submitted with errors."
"Payments will be less if... - CORRECT ANSWER down coding occurs."
"4 Modifiers - CORRECT ANSWER Total number of modifiers that can be indicated on the CMS-
1500 form."
"ERA (electronic remittance advice) - CORRECT ANSWER An electronic document that lists
patients, dates of service, charges, and the amount paid or denied by the insurance carrier."
"Neoplasms - CORRECT ANSWER Abnormal growths of new tissue that are classified as benign
or malignant."
"Cash Flow - CORRECT ANSWER The on-going availability of cash for operations in a medical
practice."
"Myocardium - CORRECT ANSWER Refers to the muscular wall of the heart."
"If an insurance company admits that a patient signed an assignment of benefits document and
that it inadvertently paid the patient instead of the physician, the insurance company should... -
CORRECT ANSWER Pay the physician within 2 to 3 weeks and honor the assignment, even
before the company recovers their money from the patient."
"January - CORRECT ANSWER CPT codes are published annually. These codes are added,
revised, and deleted each year. This month is when you would start using these codes."
"Auditing refers to... - CORRECT ANSWER Reviewing claims for accuracy and completeness."
"Abandonment - CORRECT ANSWER Discontinuing medical care without giving the proper
notice or providing a competent replacement provider."
"Cryosurgery - CORRECT ANSWER Use of cold temperatures to destroy tissue."
"Lymphatic system does what? - CORRECT ANSWER Regulates immunity."
"Neuralgia - CORRECT ANSWER Intense pain along the nerve."
"Angioplasty - CORRECT ANSWER Surgical repair or unblocking of the coronary artery."
"Pleura - CORRECT ANSWER Membrane surrounding the lungs and lining the walls of the
pleural cavities."
"18% - CORRECT ANSWER When coding a front torso burn, which of the following
percentages should be coded?"
"Block 24d - CORRECT ANSWER CPT/HCPCS codes (procedures, services, supplies)"
"ECG - CORRECT ANSWER electrocardiogram - Common abbreviation for the test that
assesses the electrical activity of the heart."
"Family, Coworkers, Friends - CORRECT ANSWER Confidential information about patients
should never be discussed with."
"Respondeat Superior - CORRECT ANSWER "Let the master answer" an employer is vicariously
liable for the behavior of an employee working within his or her scope of employment."
"Principal Diagnosis (PDX) - CORRECT ANSWER Condition established after study to be chiefly
responsible for admission to hospital."
"Clinician - CORRECT ANSWER Who is responsible for entering proper medical documentation
to support reimbursement of procedures and services?"
"Advanced Beneficiary Notice (ABN) - CORRECT ANSWER Document given to medicare
beneficiaries indicating the services medicare is unlikely to pay for."
"What does bundling mean? - CORRECT ANSWER Grouping codes that are related to a
procedure."
"Medicare Summary Notice (MSN) - CORRECT ANSWER A summary sent to the patient from
Medicare that summarizes all services provided over a period of time with an explanation of benefits provided."
"Subscriber number - CORRECT ANSWER Refers to the insurance policy number."
"cost sharing - CORRECT ANSWER Provision of a healthcare insurance policy that requires
policyholders to pay for a portion of their healthcare services; a cost-control mechanism."
"Administration Simplification Compliance Act (ASCA) - CORRECT ANSWER Part of HIPAA
policy, mandates that healthcare claims be submitted electronically."
"Electronic Data Interchange (EDI) - CORRECT ANSWER The transfer of electronic information,
such as health claims, in a standard format."
"Conditional Payment - CORRECT ANSWER Medicare payment that is recovered after primary
insurance pays."
"Resubmission Process of Claim - CORRECT ANSWER Claims with minor errors or omissions
can be resubmitted according to payer guidelines."
"Sagittal Plane - CORRECT ANSWER What plane divides the body into left and right?"
"coronal plane - CORRECT ANSWER divides body into front and back"
"Medicaid - CORRECT ANSWER A federal and state assistance program that pays for health
care services for people who cannot afford them."
"Operative report (OR) - CORRECT ANSWER chronicles the details of a surgical procedure
performed in a hospital, outpatient surgical center, or clinic."
"Plus Symbol - CORRECT ANSWER Identifies add-on codes (Appendix D of CPT) for procedures
that are commonly, but not always, performed at the same time and by the same surgeon as the primary procedure."
"CMS-1500 form - CORRECT ANSWER the standard form used by health-care providers to bill
for services, including disease state management services."
"Fields 1-13 - CORRECT ANSWER Basic information about patient or demographics."
"Block 1 - CORRECT ANSWER What type of insurance."
"Block 8 - CORRECT ANSWER Leave blank."
"Block 9 - CORRECT ANSWER Other Insured's Name"
"Block 10d: Reserved for Local Use - CORRECT ANSWER Some third-party payers require that
this boxed be used. Refer to the instructions from that applicable third-party payer."
codes are provided to an insurance company on an insurance form, they will automatically be cross-referenced to the correct code for that company."
"Block 27: Accept Assignment - CORRECT ANSWER The "accept assignment" indicates that the
provider agrees to accept assignment under the terms of the Medicare program and some other insurance payers. Check this block if the provider participates in the insurance payer's program; that is the provider is a participating physician and agrees to abide by the terms of the agreement to accept assignment and writer off the difference between the original charge and the allowable amount set by the insurance carrier."
"Block 28: Total Charge - CORRECT ANSWER The total charge is the amount billed on this claim
form for all services rendered. Add the charges reported in block 24F for all the lines of services on the claim form."
"Block 29: Amount Paid - CORRECT ANSWER The amount paid is the payment received from
the patient or other payers."
"Block 30: Balance Due - CORRECT ANSWER The amount left after the patient has paid a co-
pay or co-insurance is entered in this block."
"Block 32b: Other ID number - CORRECT ANSWER The non-NPI number of the billing provider
refers to the payer-assigned unique identifier of the professional. The 2 character qualifier of the non-NPI number is also entered in this block."
"Block 32a: NIP Number - CORRECT ANSWER Enter the NPI number of the service facility."
"Block 17a: Other ID - CORRECT ANSWER It was used previously for a personal identification
number (PIN), which became obsolete in 2008."
"Block 17b: NPI Number - CORRECT ANSWER HIPAA established the National Provider
Identification (NPI). In the past, each insurance carrier, including government programs, assigned an identifier to each provider service. All allied healthcare providers of serivce now are assigned an NPI, which the provider can use regardless of the insurance carrier being billed. The NPI replaces Medicare's Unique Provider Identification Number (UPIN) and almost all other federal, state, and private insurance carriers' Provider Identification Numbers (PINs). The NPI does not replace the Social Security number (SSN), employer identification number (EIN), or federal tax identification number (TIN) used by a provider of service. The SSN, EIN, and TIN are used for income and tax purposes and for reporting to the Internal Revenue Service."
"Block 14 - CORRECT ANSWER Date of current illness injury or pregnancy."
"Block 9: Other Insured's Name - CORRECT ANSWER The other insured's name indicates that
another insurance exists that may cover the patient. This block is completed only if there is a secondary insurance policy and that policy is to be billed."
"Block 31: Signature of Physician or Supplier - CORRECT ANSWER The signature is the
provider's verification that the claim is correct."
"DN qualifier - CORRECT ANSWER Referring Provider"
"DK qualifier - CORRECT ANSWER Ordering Provider"
"DQ qualifier - CORRECT ANSWER Supervising Provider"
"ICD-10-PCS codes contain _______ characters. - CORRECT ANSWER seven"
"ICD-10-CM Tabular List - CORRECT ANSWER 21 chapters
For some chapters, the body or organ system is the axis Other chapters group together conditions by etiology or nature of the disease process ICD-10-CM contains chapters for External Causes of Morbidity Previously known as E codes in ICD-9-CM Factors Influencing Health Status and Contact with Health Services Previously known as V codes in ICD-9-CM"
"ICD-10-PCS Section 1 - CORRECT ANSWER Where the code is indexed."
"ICD-10-PCS Section 2 - CORRECT ANSWER The body system"
"ICD-10-PCS Section 3 - CORRECT ANSWER Root operation such as excision or incision."
"ICD-10-PCS Section 4 - CORRECT ANSWER Specific body part."
"ICD-10-PCS Section 5 - CORRECT ANSWER Approach used."
"ICD-10-PCS Section 6 - CORRECT ANSWER Device used to perform the procedure."
"CPT codes are used to describe what? - CORRECT ANSWER Services rendered by the
provider."
"Character 4 of ICD-10-PCS - CORRECT ANSWER Identifies body part for medical or surgical
procedure."
"Goals of ICD-10-PCS - CORRECT ANSWER Improve accuracy and efficiency of coding, reduce
training effort, and improve communication with physicians."
"Crossover - CORRECT ANSWER When an insurance company transfers data to allow
coordination of benefits of a claim."
"What happens if Block 13 is left blank? - CORRECT ANSWER The third-party payer reimburses
the patient and the patient is responsible for reimbursing the provider."
"HIPPA compliance guidelines for electronic health records. - CORRECT ANSWER The
electronic transmission and code set standards require every provider to use the healthcare transactions, code sets, and identifiers."
"Eyeglasses and Prescription Drugs - CORRECT ANSWER Some senior HMOs provide services
not covered by Medicare such as..."
"Clearinghouse - CORRECT ANSWER a service company that receives electronic or paper
claims from the provider, checks and prepares them for processing, and transmits them in HIPAA- complaint format to the correct carriers."
"CMS (Centers for Medicare and Medicaid Services) - CORRECT ANSWER Federal agency in
the Department of Health and Human Services that runs Medicare, Medicaid, clinical laboratories, and other government health programs; responsible for enforcing all HIPAA standards other than the privacy and security standards." "Daily back-ups of the system, and storage at an offsite location, allow for restoration of
information and eliminate the risk for loss of data due to... - CORRECT ANSWER Damage from
wear-and-tear, power failure, and destruction by fire or flood."
"Medicare Administrative Contractor (MAC) - CORRECT ANSWER Processes Medicare Parts A
and B claims from hospitals, physicians, and other providers."
"Chief Complaint (CC) - CORRECT ANSWER The main reason for the patient's visit."
"Capitation - CORRECT ANSWER System of payment used by managed care plans in which
physicians and hospitals are paid a fixed, per capita amount for each patient enrolled over a stated period regardless of the type and number of services provided; reimbursement to the hospital on a per-member/per-month basis to cover costs for the members of the plan."
"Physical Safeguards - CORRECT ANSWER As amended by HITECH, security rule measures
such as locking doors to safeguard data and various media from unauthorized access and exposures; including facility access controls, workstation use, workstation security, and device and media controls."
"Authorization - CORRECT ANSWER The document that provides permission to use and
disclose individually identifiable health information other than for TPO (treatment, payment, operations)."
"CPT Codes (current procedural terminology) - CORRECT ANSWER Five digit numeric codes for
procedures & services performed by providers."
"MDM (medical decision making) - CORRECT ANSWER The physician's thought process with
these three elements: The number of potential diagnoses and management options that must be considered during an encounter. The amount and complexity of data to be reviewed as a result of the encounter. The risk of complications, morbidity and mortality associated with the encounter."
