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NHA NEW CBCS PRACTICE TESTS
QUESTIONS WITH 100% VERIFIED CORRECT ANSWERS
"Compliance Regulations - CORRECT ANSWER billing-related cases are based on HIPAA and
False Claims Act."
"implied consent - CORRECT ANSWER the MA needed to get the patient's weight, when the
patient stepped onto the scale his actions were considered"
"medical necessity - CORRECT ANSWER the diagnosis indicated that the procedure was
necessary to treat the problem, the relationship between diagnosis and procedure is reasonable or shows"
"the Aged Claims Report - CORRECT ANSWER the claim went unpaid for 63 days, the claim can
be found on which report"
"exclusion - CORRECT ANSWER a patient's policy stated that it did not cover gastric bypass
surgeries, this means that surgery is considered an"
"minimum necessary protocol - CORRECT ANSWER the Biller review the information to be
disclosed to make sure that she was disclosing the minimum amount of information needed, as per the request, this is called"
"Two provisions of HIPPA - CORRECT ANSWER Titile I: Insurance Reform
Title II: Administrative Simplification" "Insurance Reform. -Primary purpose to provide continuous insurance coverage for workers and
their dependents when they change or lose their jobs. - CORRECT ANSWER -Limits the use of
preexisting conditions exclusions -Prohibits discrimination for part or present poor health -Guarantees cetraom employees and individuals the right to purchase health insurance coverage after losing a job
- Allows renewal of health insurance coverage regardless of an individual's health condition that is covered under the particular policy"
"False Claim Act (FCA) - CORRECT ANSWER Federal law that prohibits submittimg a fraudulent
claim or making statement or representation in connection with a claim."
"National Correct Coding Initiative (NCCI) - CORRECT ANSWER Developed by the CMS to
promote national correct coding methodologies and to control improper coding that leads to inappropriate payment of part B health insurance claims."
"Office of Inspector General (OIG) - CORRECT ANSWER Investigates and prosecute health care
fraud and abuse."
"Fraud - CORRECT ANSWER Knowingly and intentionally deceiving or misrepresenting
information that may result in unauthorized benefits."
"Abuse - CORRECT ANSWER Defined as incidents or practices, not usually considered
fradulaent that are inconsistant with the accepted medical business or fiscal practices in the industry." "Patient Confidentiality- All patients have the right to privacy, and all information should remain
privileged. - CORRECT ANSWER Discuss patient information with only the patient's physician
or office personnel that need cetain information to do their job. Obtained a signed consent form to release medical infomation to the insurance company or other individual." "Under HIPPA Privacy Rule, providers may use patient's Protected Health Information (PHI)
without specific authorization for - CORRECT ANSWER Treatment: primarily for the purpose
of discussion fo the patient's case with other providers. Payment: providers submit claims on behalf of patients. Operations: for purposes such as stafff training and quality improvment."
"Employern Liability - CORRECT ANSWER Physicians are legally responsible for their own
conduct and any action of their employees (their designee) perform within the context of their employment. Refered to as "vacarious liability"also known as "respondent superior" which means "let the master answer"."
"Employee Liabiltiy - CORRECT ANSWER "Errors and omissions insurance" is protection
against loss of monies by failure through error or unintentional omission on the part of the individual or service submitting the insurance claim."
"Information needed when billing the insurance company - CORRECT ANSWER Date of service
(DOS), place of service (POS), type of service (TOS), diagnosis (dx or DX), and procedures."
"carcinoma in situ - CORRECT ANSWER cancer that is localized and has not spread to adjacent
tissue or distant parts of the body"
"secondary malignacy - CORRECT ANSWER cancer that has metasized (spread) to a secondary
site either adjacent or remote region of the body"
"3 sections of Alphabetic index - CORRECT ANSWER Section 1: Index to Diseases: each term is
followed by the code or codes that apply to that term Section 2: Table of Drugs and Chemiclas: contains list of drugs and chemicals with corresponding poisoning codes and E codes."
"Category I codes - CORRECT ANSWER respresent services and procedures widely used by
many health care professional in clinical practice in multiple locations and have been approved by the FDA"
"Category II codes - CORRECT ANSWER supplemental codes used for performance
measurements."
"Category III codes - CORRECT ANSWER temporary codes for emerging technology, services
and procedures. If a Category III code is available, it is reported instead of a Category I unlisted code."
"stand-alone code - CORRECT ANSWER contain the full description of the procedure for the
code"
"modifiers - CORRECT ANSWER provide the means by which the reporting physician can
indicate that a service or procedurethat has been performed has been altered by some specific circimstance but not change in its definition or code."
"A triangle - CORRECT ANSWER symbol in the CPT manual that represents a change in the
code description since the last edition. The change may be minor or significant and it could be and addition, deletion or revision."
"Two trianguar symbols - CORRECT ANSWER represents changes in the text or definition
between the triangles"
"bullet - CORRECT ANSWER a new procedure or service code added since the previous edition
of the manual"
"a plus sign - CORRECT ANSWER indicates a add-on codes"
"circle with a line through it - CORRECT ANSWER Exemption from the use of modifier -51"
"CPT Modifiers - CORRECT ANSWER two-digit add- on codes attached to regular codes to tell
third party payers of circumstances in which the serices procedures were altered. Listed in Appendix A"
"-24 - CORRECT ANSWER Unrelated E/M Services by the Same Physician During a
Postoperative Period"
"-26 - CORRECT ANSWER Professional Component"
"-32 - CORRECT ANSWER Mandated Services"
"-50 - CORRECT ANSWER Bilateral Procedure"
"-51 - CORRECT ANSWER Multiple Procedures"
"-58 - CORRECT ANSWER Staged or Related Procedure or Service by the same Physician during
the Postoperative Period"
"-78 - CORRECT ANSWER Return to Operating Room for a Related Procedure during the
Postoperative Period"
"-79 - CORRECT ANSWER Unrelated Procedure by the Same Physician During the
Postoperative Period"
"-90 - CORRECT ANSWER Reference (Outside) Laboratory"
"-99 - CORRECT ANSWER Multiple Modifiers"
"Unlisted Procedures - CORRECT ANSWER considered experimental, newly approved, or
seldom used may not be listed in the CPT Manual."
"Relative Value for Physicians (RVP) - CORRECT ANSWER has no geographic adjustment factor
or individual RVU component to calculate. However, for each category of procedures, a separate conversion factor must be developed"
"contracted rates with MCO's - CORRECT ANSWER physicians agree to provide sevices at a
discount of their usual fee in return for a pool of existing patients"
"capitated rates - CORRECT ANSWER the physician provides a full range of contracted sevice
to covered patients for a FIXED amount on a periodic basis/monthly"
"medicare - CORRECT ANSWER the federal government's health insurance program created
by the Social Security Act 1965 titled " Health Insurance for the Aged and Disabled". It is an entitlement program administered by the Centers for Medicare and Medicaid Services (CMS),"
"Medicare available to - CORRECT ANSWER -persons 65 years or older, retired on Social
Security benefits -those diagnosed with end-stage rental disease (ESRD) -kidney donors to ESRD patients (all expenses related to the kidney trasplantation are covered)" "Part A- Hospital Insurance for the Aged and Disabled.
Covers inpatient, hospice, and home health services, such as: - CORRECT ANSWER bed patient
in the hospital, patient in a psychiatric hospital, bed patient in a nursing facility, patient recieving home health care services, terminally ill patient who has six monts or less to live and needs hospice care, terminally ill patients who needs respite care"
"Part B - CORRECT ANSWER Supplementary Medical Insurance (SMI). Supplement to Part A.,
paid through beneficiaries' soc sec benefits. It has an annual deductible and beneficiaries pay 20%."
"Part C Medicare Managed Care Plan - CORRECT ANSWER (Formerly Medicare Plus(+) Choice
Plan) created to offer a number of healthcare services in available under Part A and Part B."
"Part D Prescription Drugs - CORRECT ANSWER Medicare beneficiaries can enroll and have a
choice among several plans that offer drug coverage for which they pay a monthly premium."
"Medigap or Medicare Supplemental Insurance - CORRECT ANSWER To pay for medical
services and items tha t Medicare does not cober and Medicare's coinsurance and dedutibles,
beneficiaries may purchase a supplemental insurance. Private insurance designed to help pay for those amounts that are typically the patient;s responsibility under Medicare."
"Medicaid - CORRECT ANSWER federal program administrated by state and governments to
provide medical assistance to the needy. Each state sets its own guidelines for eligibility and services."
"payer of last resort - CORRECT ANSWER Medicaid"
"workers compensation - CORRECT ANSWER is a state-required insurance plan, the coverage
of which provides benifits to employees and their dependents for work related injury, illness or death"
"disability insurance - CORRECT ANSWER defined as reimbursement for income lost as a
result of a temporary of permanent illness or injury"
"liabiltiy insurance - CORRECT ANSWER policy that covers losses to a third party caused by the
insure, by an object owned by the insured, or on premises owned by the insured"
"Tricare - CORRECT ANSWER managed health care program fo active duty and retired
members of the armed forces, their families, and survivors. Service benefit program that requires no premium."
"CHAMPVA - CORRECT ANSWER created to povide medical benefits to spouses and children
of veterans with total, permanent service related disabilities or for surviving spouses and children of a veteran who died as a result of service related disability"
"types of claims - CORRECT ANSWER paper claims or electronic claims through
clearhinghouses"
"CMS-1500 - CORRECT ANSWER Standardized claim form"
"2 major sections of CMS-1500 - CORRECT ANSWER Blocks 1-13 patient information
Blocks 14-33 refers to physician infromation"
"non-covered benefits - CORRECT ANSWER is any procedure or service reported on the
insurance claim form that is not listed in the payer's master benefit list"
"co-payment - CORRECT ANSWER cost-sharing requirement for the insured to pay at the time
of service."
"coinsurance - CORRECT ANSWER is a percentage of the cost of covered services that a
policyholder or a seconday insruance pays"
"coding - CORRECT ANSWER process of converting diagnose, procedures, and services into
numeric and alphanemeric characters"
"medical necessity - CORRECT ANSWER defined by Medicare as "the determination that a
service or procedure rendered is reasonable and necessary for the diagnosis of treatment of an illness or injury"
"exclusions and limitations - CORRECT ANSWER conditions, situations, and services not
covered by the insurance carrier"
"pre-certification - CORRECT ANSWER to determine coverage for a specific treatment such as
surgery, hospitalization or test, under the insured's policy"
"pre-determination - CORRECT ANSWER to determine the patient's benifits and the
maximum dollar amount that eht insurance company will pay. Often determined at first visit"
"pre-authorization - CORRECT ANSWER requirement for some health insurance plans to
obtain permission for a service or procedure before it is done."
"qualified diagnosis - CORRECT ANSWER working diagnosis which is not yet established"
"eligibiltiy - CORRECT ANSWER qualifying factor of factors that must be met before a patient
receives benefits"
"coordination of benefits (COB) - CORRECT ANSWER when two insurance companies work
together to coordinate payment of the benefits"
"encounter form - CORRECT ANSWER also called a superbill; it is a listing of the diagnoses,
procedures, and charges for a patient's visit"
"itemized statement - CORRECT ANSWER a statment of the patient's account history, showing
dates of service, the detailed charges, payments (deductibles and co-pays), the date the insurance claim was submitted, applicable adjustments and account balance."
"peer review organization (PRO) - CORRECT ANSWER state based group pf physicians working
under government guideline to review cases and determine their appropriatness and quality of professional care"
"Civil Monetary Penlties Law - CORRECT ANSWER law passed by the federal government to
prosecute cases of Medicaid fraud"
"The Good Samaritan Act - CORRECT ANSWER developed to protect healthcare professionals
from liabiltiy of any civil damages as a result of rendering emergency care"
"remittance advice - CORRECT ANSWER electronic or paper-based report of payment sent by
the payer to the provider"
"Patient Care Partnership (Patient Bill of Rights) - CORRECT ANSWER developed to promote
the interests and well being of patients and residents of the healthcare facility. This bill still has not become law"
"pphysician - CORRECT ANSWER doctor of medicine or osteopathy, dental medicine, dental
surgery, podiatric medicine, optometry, or chiropractice medicine legally authorized to practice by the state in which he/she performs"
"health practitioner - CORRECT ANSWER includes, but not limited to, physician assistant,
cetified nurse-midwife, qualified psychologist, nurse practitioner, clinical social worker, physical therapist, occupational therapist, respiratory therapist, cettfied nurse anesthetist, or any other practitioner as may be specified."
"group practice - CORRECT ANSWER group of two or more physicians and non-physician
practitioners legally organized in a partnership, professional corporation, foundation, not-for- profit corporation faculty practice plan, or similar association"
"parcticipating physician - CORRECT ANSWER one who has a contract with a health insuranc
plan and accepts whatever the plan pays for procedures or serices rendered"
"nonparticipationg physician - CORRECT ANSWER one who has no cntract with the health
insurance plan"
"lymphatic system - CORRECT ANSWER distributes fluids and nutrients throughout the body"
"lymphatic system - CORRECT ANSWER lymph nodes are a part of which body system"
"integumentary system - CORRECT ANSWER regulates body temperature and sensory
receptors to external stimuli"
"integumentary system - CORRECT ANSWER the skin absorbs Vitamin D through which body
system"
"nervous system - CORRECT ANSWER receives information and interprets via electrical signals
carried by nerves"
"nervous system - CORRECT ANSWER the brain and spinal cord are part of which body
system"
"circulatory system - CORRECT ANSWER which body system includes the heart, veins and
arteries"
"respiratory system - CORRECT ANSWER which body system includes the lungs"
"respiratory system - CORRECT ANSWER Chronic Obstructive Pulmonary Disease COPD
effects which body system"
"urinary system - CORRECT ANSWER which body system includes the bladder, urethra and
kidneys"
"clean claim - CORRECT ANSWER a claim that has no data errors"
"pending claim - CORRECT ANSWER a claim that is awaiting additional information"
"dirty claim - CORRECT ANSWER a claim with incorrect information"
"invalid claim - CORRECT ANSWER a claim that is not accepted by the insurance company
because of missing but necessary information"
"upcoding - CORRECT ANSWER assigning codes to get higher insurance reimbursement"
"ICD-10 - CORRECT ANSWER the newest version of the diagnostic coding manual has more
detailed clinical information and expanded injury codes,"
"ICD-10 - CORRECT ANSWER this version of the diagnostic coding manual contains an
alphabetic first character"
"ICD-9 - CORRECT ANSWER this version of the diagnostic coding manual contains 3 to 5 digit
codes"
"ICD-10 - CORRECT ANSWER this version of the diagnostic coding manual contains 3-7 digit
alphabetic numerical characters"
"ICD10 PCS - CORRECT ANSWER these are new procedure codes in the ICD-10 CM, for
inpatient procedures"
"modifier - CORRECT ANSWER what is the term for a 2 digit code that indicates an altered
procedure"
"a medical insurance claim - CORRECT ANSWER a billable record of the diagnosis and services
provided for a patient is a"
"abstracting - CORRECT ANSWER the process of translating medical documentation into
codes is called"
"COB - CORRECT ANSWER coordination of benefits"
"COB - CORRECT ANSWER to determine which insurance is primary or secondary"
"Notice of Privacy Practices NPP - CORRECT ANSWER document that must be given to all new
patients indicating how their PHI will be used, also known as the Patient Care Partnership is the"
"treatment, payment and operations TPO - CORRECT ANSWER per HIPAA, an authorization is
not needed when using patient's PHI for treatment, payment and operations in the office is"
"ROI - CORRECT ANSWER an authorization to release PHI to other parties, which is signed by
the patient"
"PHI - CORRECT ANSWER protected health information"
"implied consent - CORRECT ANSWER non verbally giving permission by action or gesture"
"informed consent - CORRECT ANSWER being informed of all aspects including the pros, cons
and prognosis of a procedure is called"
"OCR - CORRECT ANSWER Office of Civil Rights"
"OCR - CORRECT ANSWER the federal organization designated by HHS to investigate privacy
and confidentiality complaints"
"OIG - CORRECT ANSWER the federal organization that levies penalties and fines for fraud,
specifically Medicare and Medicaid is"
"OIG - CORRECT ANSWER Office of Inspector General"
"minimum necessary - CORRECT ANSWER releasing only what is necessary to comply with a
request for patient PHI is called"
"reconciliation - CORRECT ANSWER the process of determining how much the provider has
been reimbursed and what the patient still owes is called"
"ABN - CORRECT ANSWER Advanced Beneficiary Notice"
"ABN - CORRECT ANSWER a document signed by the patient that indicates they will be
responsible for any charges not covered by Medicare"
"HITECH - CORRECT ANSWER a reform of the HIPAA act that concerns patient privacy, and
protecting PHI, TITLE II,"
"Medicare Part A - CORRECT ANSWER hospital or inpatient coverage"
"RA - CORRECT ANSWER Remittance Advice"
"Remittance Advice RA - CORRECT ANSWER document sent to providers with reimbursement
information for numerous patients"
"EOB - CORRECT ANSWER document sent to the patient explaining what charges were paid by
the insurance company and what is patient responsibility"
"EOB - CORRECT ANSWER explanation of benefits"
"Accounts Receivable - CORRECT ANSWER outstanding balances due to the office"
"Petty Cash - CORRECT ANSWER small amount of money kept in the office for incidentals"
"CLIA - CORRECT ANSWER Clinical Laboratory Improvement Amendments, sets quality
standards for laboratory testing"
"MS-DRG - CORRECT ANSWER what is software used to assign Medicare diagnosis groups
based on level of service such as severity of illness or injury"
"NCCI - CORRECT ANSWER National Correct Coding Initiative"
"Petty cash - CORRECT ANSWER _____________, the amount that should always be
documented as it occurs"
"off site - CORRECT ANSWER where should the system back up be kept"
"Aged Claims - CORRECT ANSWER claims that have not been paid within 30 days"
"Appeals Process - CORRECT ANSWER the process of asking the insurance company to review
a denied claim"
"EIN - CORRECT ANSWER federal identification number for incorporated entities, Employer
Identification Number"
"NPI - CORRECT ANSWER CMS requires each Provider to have an unique identification
number, National Provider Identification Number"
"copayment - CORRECT ANSWER the amount the patient pays that the time of services"
"premium - CORRECT ANSWER the monthly amount paid to keep the policy in effect is called"
"coinsurance - CORRECT ANSWER the percentage of each service that the patient pays"
"assignment of benefits - CORRECT ANSWER the authorization from the patient for payment
for services to be sent directly to the provider"
"accepting assignment - CORRECT ANSWER the provider agrees to the amount the carrier will
pay for the services, this is called"
"AMA - CORRECT ANSWER organization that maintains the CPT manual"
"WHO - CORRECT ANSWER organization that maintains the ICD-9 manual"
"beneficiary - CORRECT ANSWER Medicare and Medicaid use this term to describe the
insured"
"fraud - CORRECT ANSWER intentional act to deceive for financial gain"
"audit - CORRECT ANSWER formal examination of patient medical records and accounts"
"bundle code - CORRECT ANSWER a group of related procedures covered by one single code"
"CHAMPVA - CORRECT ANSWER insurance covering retired and disabled veterans"
"clearinghouses - CORRECT ANSWER a company that receives data from the provider, scrubs
it for errors and forwards it on to the insurance company is"
"code linkage - CORRECT ANSWER the process of joining a diagnosis code and a procedure
code for the purpose of justifying medical necessity"
"compliance officer or privacy officer - CORRECT ANSWER individual responsible for reviewing
office polices and procedures to make sure they are HIPAA compliant"
"CPOE - CORRECT ANSWER a process of electronic order entry for physicians which reduces
medical errors"
"chief complaint - CORRECT ANSWER reason why the patient is seeking to see a physician"
"CHIP - CORRECT ANSWER Children's Health Insurance Program"
"CHIP - CORRECT ANSWER program that provides health insurance to all uninsured children
and teens, who are not enrolled in Medicaid"
"CMS 1500 - CORRECT ANSWER what is the paper format for outpatient health insurance
claims"
"XII 837 P - CORRECT ANSWER what is the electronic format of the CMS 1500, for outpatient
or provider billing"
"XII 837 I - CORRECT ANSWER what is the electronic format of the UB-04, for inpatient or
hospital billing"
"UB-04 - CORRECT ANSWER what is the paper format for inpatient health insurance claims"
"conversion factor - CORRECT ANSWER dollar amount used to multiply relative value units to
create a fee schedule for Medicare"
"RBRVS - CORRECT ANSWER Resource Based Relative Value Scale"
"RBRVS - CORRECT ANSWER method used by Medicare to arrive at fees for provider services"
"covered enities - CORRECT ANSWER healthcare providers who transmit any PHI in the
electronic format"
"DRG - CORRECT ANSWER Diagnosis Related Groupsf medically related diagnosis and
treatment"
"diaability insurance - CORRECT ANSWER insurance that covers medical treatment and wages
for a patient unable to work is called"
"crossover - CORRECT ANSWER Medicare pays the claim and then crosses the claim over to
the secondary for payment, aleviationg the need to submit the claim a second time"
"downcode - CORRECT ANSWER the insurance carrier reimburses at a lower level, for services
rendered is called"
"EHR - CORRECT ANSWER electronic health records"
