Download NHA CBCS Final Practice Test: 100% Verified Answers 2024/2025 and more Exams Medicine in PDF only on Docsity!
NHA CBCS FINAL PRACTICE TEST
100% VERIFIED ANSWERS 2024/2025 CORRECT
ALREADY PASSED
"Which of the following coding manuals is use to identify products, supplies and services? -
CORRECT ANSWER HCPCS Level II"
"In which of the following scenarios is it appropriate to release a patient's psychiatric records
without the patient's consent? - CORRECT ANSWER When the patient is being investigated by
the police" "A billing and coding specialist is reviewing a Medicare Part C denial for a patient who was injured
on the job. The Specialist should expect which of the following to be the reason for the denial? -
CORRECT ANSWER Medicare is not the primary insurance"
"Which of the following is the purpose of precertification? - CORRECT ANSWER To verify
coverage" "Which of the following is entities outlines the minimum essential elements of a comprehensive
program? - CORRECT ANSWER Office of inspector General (OIG)"
"Which of the following is the process of sending an insurance claim through a series of edits for
final determination? - CORRECT ANSWER Adjudication"
"Two providers are having a conversation about a patient's test results at the nursing station. A different patient overhears them talking. This type of privacy exposure is known as which of the
following? - CORRECT ANSWER Incidental disclosure"
"Which of the following actions by a billing and coding specialist prevents fraud? - CORRECT
ANSWER Performing periodic audits"
"A billing and coding specialist is preparing a claim for an esophagectomy. Which of the following
types of service is being provided? - CORRECT ANSWER Removal"
"An internal retrospective billing account audit prevents fraud and abuse by reviewing and
comparing completed claim forms with which of the following? - CORRECT ANSWER
Documentation from patient encounters" "A billing and coding specialist is preparing a claim for a procedure that typically takes about 2 hr. Due to complications, it took 4.5 hr to complete the procedure. Which of the following modifiers
should the specialist use? - CORRECT ANSWER -22: Increased procedural services"
"Which of the following are included in the ICD-10-CM code set?
- Fracture reduction
- Spiral fracture
- Cast application
- Walking boot - CORRECT ANSWER Spiral fracture" "In which of the following circumstance should a billing and coding specialist submit a claim with
an attachment to a third-party payer? - CORRECT ANSWER When a claim contains unlisted
procedure codes" "Which of the following describes the status of a claim that is in process and does not include
required preauthorization for a service? - CORRECT ANSWER denied"
"Which of the following information should a billing and coding specialist use to determine which
accounts should be submitted to collections? - CORRECT ANSWER The age of the account"
"A billing and coding specialist is resubmitting denied claims. Which of the following should alert the specialist that a claim will require additional medical record documentation before the third-
party payer can approve it? - CORRECT ANSWER The patient is now deceased."
"Which of the following plans requires providers to adhere to managed care provisions? -
CORRECT ANSWER health maintenance organization (HMO) plan"
"Which of the following health maintenance organization (HMO) managed care services requires
a referral? - CORRECT ANSWER Annual gynecological services provided by the primary care
provider."
"Which of the following can be performed when billing procedural codes? - CORRECT
ANSWER Billing using two-digit CPT® modifiers to indicate a procedure performed differs from
its usual five-digit code"
"Which of the following government agencies is responsible for combating fraud and abuse in
health insurance and health care delivery? - CORRECT ANSWER Office of Inspector General
(OIG)"
"A billing and coding specialist is reviewing a patient's account and notes there is an outstanding balance that is 45 days old after third-party payer reimbursement. Which of the following actions
should the specialist take? - CORRECT ANSWER Send the patient an itemized statement to
collect the outstanding balance." "Which of the following should a billing and coding specialist file for a new workers'
compensation claim? - CORRECT ANSWER First report of injury"
"Which of the following procedures refers to the removal of kidney stones? - CORRECT
ANSWER nephrolithotomy"
"A billing and coding specialist is reviewing a letter from a patient's third-party payer about an emergency procedure that was performed for the patient. The letter states that preauthorization requirements were not met and the claim was denied. Which of the following actions should the
specialist take? - CORRECT ANSWER Send an appeal letter to the third-party payer."
"Which of the following can increase the value of a CPT® code? - CORRECT ANSWER
Modifiers" "A patient who has a health maintenance organization (HMO) insurance plan needs to see a
specialist. From which of the following should the patient obtain a referral? - CORRECT
ANSWER primary care provider"
"Which of the following is the goal of revenue cycle monitoring? - CORRECT ANSWER Ensuring
financial viability using standards of measurement" "A patient who experienced identity theft is trying to investigate how it occurred. The patient asks a billing and coding specialist for assistance in determining if the breach might have originated in
the provider's office. Which of the following actions should the specialist take? - CORRECT
ANSWER Provide an accounting of disclosures"
"Which of the following actions is an example of fraud? - CORRECT ANSWER Billing for
services that are not medically necessary"
"ICD-10-CM codes must be a minimum of how many characters without being subdivided? -
CORRECT ANSWER Three"
"Which of the following actions should a billing and coding specialist take if Medicare denies a
service as not medically necessary? - CORRECT ANSWER Appeal the decision with supporting
documentation." "A billing and coding specialist is completing a CMS-1500 claim form for a patient who was
involved in a motor-vehicle crash. Which of the following information is required on the form? -
CORRECT ANSWER date of injury"
"A patient who has a past due balance requests their records be sent to another provider. Which of the following actions should the billing and coding specialist take with regards to the records
request? - CORRECT ANSWER Begin collection action on the balance due."
"Which of the following is an example of electronic claim submission? - CORRECT ANSWER
Submitting claims via a secure network" "A third-party payer requests a patient's information related to a claim. A billing and coding specialist should ensure that which of the following is included in the patient's file before
providing the information? - CORRECT ANSWER Signed release of information form"
"A billing and coding specialist is preparing a claim for a participating provider whose billed amount is $175.00 for an encounter. The third-party payer's allowed amount is $90.00 for the service rendered, including a $20.00 copay. The specialist should recognize that which of the
following is the provider's write-off amount? - CORRECT ANSWER $
- $90 + $20 copayment = $
- $175 - $110 =$65" "A billing and coding specialist should consider which of the following when determining an
Evaluation and Management (E/M) code? - CORRECT ANSWER place of service"
"Which of the following terms describes the process used to challenge a third-party payer's
decision to deny, reduce, or downcode a claim? - CORRECT ANSWER appeal"
"When using a coding manual, the billing and coding specialist should reference which of the
following first? - CORRECT ANSWER The alphabetic index"
"Which of the following care plan models pays a provider to manage patient health care services
by expending a monthly capitation amount paid by a third-party payer? - CORRECT ANSWER
MCO"
"Which of the following parties requires signed authorization from a 32-year-old patient to access
the patient's protected health information (PHI)? - CORRECT ANSWER The patients family
member"
"Which of the following will result in a claim being rejected? - CORRECT ANSWER An ICD-10-
PCS code used as the primary diagnosis in an inpatient setting" "Which of the following should a billing and coding specialist include in an authorization for
release of information form? - CORRECT ANSWER the entity to whom the information is to be
released" "Which of the following requires companies with 20 or more workers to offer employees who are
laid off the ability to buy into the company's health insurance coverage for 18 months? -
CORRECT ANSWER Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA)"
"A billing and coding specialist is reviewing a remittance advice for a commercial health care plan. The physician is a participating provider. Under the contract with the commercial plan, which of the following determines payment for
each code? - CORRECT ANSWER fee schedule"
"A participating Blue Cross Blue Shield (BCBS) provider receives an explanation of benefits for a patient account. The billed amount was $100. BCBS allowed $80 and $40 was applied to the patient's annual deductible. BCBS paid the balance at 80%.
How much should the patient expect to pay? - CORRECT ANSWER $
- 0.80 x $40 = $
- 0.20 x $40 =$
- $40 + $8 =$48" "A provider bills $500 to a patient. After submitting the claim to the third-party payer, the claim is returned with a $500 allowed amount and no reimbursement. The patient still owes $500 for the
year. Which of the following describes the patient's financial responsibility? - CORRECT
ANSWER deductible"
"A provider performs a follow up visit of a patient who has asthma. The patient reports breakthrough wheezing. The provider prescribes a new medication. Which of the following
describes the level of the medical decision-making? - CORRECT ANSWER Moderate"
"Which of the following codes are used to code diseases, injuries, impairments, and other health-
related problems? - CORRECT ANSWER ICD-10-CM codes"
"A patient has managed care insurance and has been referred to a specialist for gastric bypass surgery.
Which of the following is needed to ensure payment? - CORRECT ANSWER preauthorization"
"A billing and coding specialist is preparing a claim for a colonoscopy. At the start of the procedure, the provider determined that the patient had not properly prepared for the procedure, so the procedure was immediately stopped. Which of the following modifiers should
the specialist use? - CORRECT ANSWER 53"
"A beneficiary of a Medicare/Medicaid crossover claim submitted by a participating provider is
responsible for which of the following percentages? - CORRECT ANSWER 0%"
"Which of the following is the percentage for which a patient is financially responsible after the
deductible has been met? - CORRECT ANSWER Coinsurance"
"Which of the following describes a claim that is 120 days old? - CORRECT ANSWER
delinquent"
"Which of the following is an example of a breach of patient confidentiality? - CORRECT
ANSWER Discussing patient information in a public space"
"A billing and coding specialist is submitting a claim to a secondary third-party payer. Which of the
following documents should the specialist attach? - CORRECT ANSWER An Explanation of
Benefits (EOB)" "Which of the following is the maximum number of diagnoses that can be reported on the CMS-
1500 claim form before an additional claim is required? - CORRECT ANSWER 12"
"A patient has an emergency appendectomy while on vacation. The claim is rejected due to the patient obtaining services out-of-network. Which of the following information should be included
in the claim appeal? - CORRECT ANSWER The patient was out of town during the emergency"
"A billing and coding specialist is completing an outpatient claim form for a Medicare beneficiary.
Which of the following is relevant to billing outpatient services? - CORRECT ANSWER ABNs are
needed when medical necessity is uncertain." "A billing and coding specialist is reviewing the CPT® coding manual with a trainee. The trainee asks why the Evaluation and Management (E/M) codes are located in the front of the manual, since they start with "99" and the rest of the manual is in numeric order. Which of the following
statements should the specialist make? - CORRECT ANSWER "Evaluation and management
codes are commonly used."" "Which of the following is a congenital condition in which the urethra opens on the lateral aspect
of the penis? - CORRECT ANSWER epispadias"
"Which of the following reports should a billing and coding specialist use to determine which
claims have been rejected? - CORRECT ANSWER Scrubber report"
"Which of the following is a key protection standard of the HIPAA Privacy Rule that requires covered entities and business associates to limit the use or release of protected health
information (PHI)? - CORRECT ANSWER Minimum necessary"
"Which of the following is a document about patient rights that is required to be signed by the
patient to acknowledge receipt and can be provided to the patient upon request? - CORRECT
ANSWER Notice of Privacy Practices (NPP)"
"When posting a payment, which of the following items should the billing and coding specialist
include? - CORRECT ANSWER Patient's responsibility"
"Which of the following is the correct sequencing of diagnosis codes for an outpatient claim? -
CORRECT ANSWER The suspected condition is the principal code."
"Which of the following actions should a billing and coding specialist take to effectively manage
accounts receivable? - CORRECT ANSWER Collect copayment from the patient at the time of
service"
"A billing and coding specialist is posting charges for a provider who performed an incision and drainage of an abscess of a Bartholin's gland. Which of the following anatomic sites includes the
Bartholin's glands? - CORRECT ANSWER vulva"
“Which of the following is an example of a consultation? - CORRECT ANSWER When a
provider requests the advice of another provider" "Which of the CPT codes should a billing and coding specialist use to indicate total prosthetic
specific antigen (PSA) test? - CORRECT ANSWER 84153 Prostate specific antigen (PSA); Total"
"Which of the following is the purpose of a claims clearinghouse? - CORRECT ANSWER To
identify errors that will prevent a claim from being paid" "A billing and coding specialist is preparing a claim for a patient who had an Evaluation and Management (E/M) visit for abdominal pain that resulted in the decision to remove the appendix immediately. Which of the following modifiers should the specialist use for this claim? -24: Unrelated evaluation and management service by the same physician or other qualified health care professional during a postoperative period. -25: significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service. -51: Multiple procedures
-57: Decision for surgery - CORRECT ANSWER -57: Decision for surgery"
"A billing and coding specialist notices that there have recently been several appeals for denials due to failure to obtain procedure preauthorization. Which of the following actions should the
specialist take? - CORRECT ANSWER Schedule an office training session about procedures that
require preauthorization." "A billing and coding specialist is preparing a claim that includes a code for miscellaneous supply. Which of the following actions should the specialist take to ensure the claim will be paid the first
time it is submitted? - CORRECT ANSWER Add supplemental documentation with the claim."
"Which of the following is a similarity between a health maintenance organization (HMO) and a
preferred provider organization (PPO)? - CORRECT ANSWER Both plans allow patients to be
seen out of network at an increased cost."
"A billing and coding specialist is calculating a patient's financial responsibility for a service rendered by a non-participating Medicare provider.
Which of the following terms refers to the amount that the patient is responsible for paying? -
CORRECT ANSWER balance billing"
"A patient is admitted to a facility with a primary diagnosis of pneumonia due to Streptococcus pneumoniae. The patient also has a history of chronic obstructive pulmonary disease (COPD) and hypertension. During the patient's stay at the facility, they experience an acute exacerbation of COPD. Which of the following indicates the correct order in which the billing and coding specialist
should report the ICD-10-CM codes? - CORRECT ANSWER J13,J44.1,110"
"A billing and coding specialist is using an accounts receivable aging report to determine which accounts should be sent to collections. According to best practices, which of the following
accounts should the specialist send to collections? - CORRECT ANSWER An account that has a
balance of $600 and is 135 days old"
