NHA Certified Billing and Coding Specialist
(CBCS) Exam Study Set 2026/2027 | 100
Verified Questions with Detailed Coding
Explanations
Section 1: The Revenue Cycle and Regulatory
Compliance (Questions 1-15)
Focus: HIPAA, compliance regulations, fraud and abuse, ethics, revenue
cycle management, and medical documentation.
Q1. A patient's health plan is referred to as the payer of last resort.
The patient is covered by which of the following health plans?
A) CHAMPVA
B) Medicare
C) TRICARE
D) Medicaid
Answer: D
Rationale: Medicaid is always the payer of last resort . This means that all
other available insurance resources must be exhausted before Medicaid will
pay. If a patient has other coverage (e.g., private insurance, Medicare), that
coverage must be billed first.
Q2. A provider charged $500 to a claim that had an allowable
amount of $400. In which of the following columns should the CBCS
apply the non-allowed charge?
A) Reference column (For notations)
B) Description column
C) Payment column
D) Adjustment column of the credits
Answer: D
,Rationale: The non-allowed charge ($100 difference) should be applied to
the adjustment column of the credits . This adjustment represents the
contractual write-off between what the provider charged and the insurance
company's allowed amount.
Q3. Which of the following statements is correct regarding a
deductible?
A) Coinsurance is a type of deductible
B) The physician should write off the deductible
C) The insurance company pays for the deductible
D) The deductible is the patient's responsibility
Answer: D
Rationale: The deductible is the amount the patient must pay out-of-pocket
before the insurance company begins to pay . Deductibles are the patient's
financial responsibility, not the physician's.
Q4. Which of the following acts applies to the administrative
simplification guideline?
A) Deficit Reduction Act of 2005
B) The Patient Protection and Affordable Care Act 2009
C) National Correct Coding Initiative of 1995
D) HIPAA
Answer: D
Rationale: The Health Insurance Portability and Accountability Act (HIPAA)
includes Title II: Administrative Simplification . This provision focuses on
reducing healthcare administrative costs and burdens through standardized
electronic transactions, privacy, and security procedures.
Q5. Which of the following describes the content of a medical
practice aging report?
A) An overview of the practice's net worth
B) An overview of the practice deposits
C) An overview of the practice's debts
D) An overview of the practice's outstanding claims
Answer: D
Rationale: An aging report provides an overview of the practice's
outstanding claims . It organizes accounts receivable by the length of time a
balance has been outstanding (e.g., 30, 60, 90, 120+ days).
,Q6. What are the possible consequences of inaccurate coding and
incorrect billing? (Select all that apply)
A) Delayed processing and payment of claims
B) Reduced payments or denied claims
C) Fines and imprisonment
D) Exclusion from payer programs
Answer: A, B, C, D
Rationale: All options are potential consequences of inaccurate coding and
incorrect billing . Consequences range from delayed payments to criminal
prosecution, fines, imprisonment, and exclusion from payer programs like
Medicare and Medicaid.
Q7. Under the HIPAA Privacy Rule, when may providers use
Protected Health Information (PHI) without specific patient
authorization?
A) For Treatment, Payment, and Healthcare Operations (TPO)
B) For marketing purposes
C) For sale to third-party vendors
D) For research without IRB approval
Answer: A
Rationale: Under the HIPAA Privacy Rule, providers may use PHI without
specific patient authorization for Treatment, Payment, and Healthcare
Operations (TPO) . This includes activities such as training staff and quality
improvement.
Q8. Which of the following is the correct term for an amount that
has been determined to be uncollectible?
A) Discounted fee
B) Bad debt
C) Financial hardship
D) Professional courtesy
Answer: B
Rationale: Bad debt is the term for an amount that has been determined to
be uncollectible . After reasonable collection efforts have failed, the amount
may be written off as bad debt.
Q9. An employer is legally responsible for their own conduct and for
the actions of employees performed within the context of their
employment. This is called:
, A) Vicarious liability (Respondeat superior)
B) Errors and omissions insurance
C) Compliance regulation
D) Risk management
Answer: A
Rationale: Vicarious liability, also known as "respondeat superior" (let the
master answer), means physicians are legally responsible for their own
conduct and any actions of their employees performed within the context of
their employment .
Q10. Which of the following is an example of a violation of an adult
patient's confidentiality?
A) A CBCS queries the physician about a diagnosis in a patient's medical
record
B) The physician uses his home phone to discuss patient care with the
nursing staff
C) While reviewing a claim, the CBCS reads the diagnosis before
realizing that the patient is a neighbor
D) A provider updates a patient's family on the patient's condition after the
patient has given permission
Answer: C
Rationale: Reading a patient's diagnosis before realizing the patient is a
neighbor is a violation of confidentiality . Even if unintentional, accessing a
patient's information without a legitimate reason is a breach.
Q11. Patient charges that have not been paid will appear in which of
the following?
A) Accounts receivable
B) Accounts payable
C) Tracer
D) Rejected claim
Answer: A
Rationale: Accounts receivable (A/R) represents money owed to the practice
for services already provided but not yet paid . Unpaid patient charges are
recorded in accounts receivable.
Q12. Compliance regulations are primarily based on which of the
following?
(CBCS) Exam Study Set 2026/2027 | 100
Verified Questions with Detailed Coding
Explanations
Section 1: The Revenue Cycle and Regulatory
Compliance (Questions 1-15)
Focus: HIPAA, compliance regulations, fraud and abuse, ethics, revenue
cycle management, and medical documentation.
Q1. A patient's health plan is referred to as the payer of last resort.
The patient is covered by which of the following health plans?
A) CHAMPVA
B) Medicare
C) TRICARE
D) Medicaid
Answer: D
Rationale: Medicaid is always the payer of last resort . This means that all
other available insurance resources must be exhausted before Medicaid will
pay. If a patient has other coverage (e.g., private insurance, Medicare), that
coverage must be billed first.
Q2. A provider charged $500 to a claim that had an allowable
amount of $400. In which of the following columns should the CBCS
apply the non-allowed charge?
A) Reference column (For notations)
B) Description column
C) Payment column
D) Adjustment column of the credits
Answer: D
,Rationale: The non-allowed charge ($100 difference) should be applied to
the adjustment column of the credits . This adjustment represents the
contractual write-off between what the provider charged and the insurance
company's allowed amount.
Q3. Which of the following statements is correct regarding a
deductible?
A) Coinsurance is a type of deductible
B) The physician should write off the deductible
C) The insurance company pays for the deductible
D) The deductible is the patient's responsibility
Answer: D
Rationale: The deductible is the amount the patient must pay out-of-pocket
before the insurance company begins to pay . Deductibles are the patient's
financial responsibility, not the physician's.
Q4. Which of the following acts applies to the administrative
simplification guideline?
A) Deficit Reduction Act of 2005
B) The Patient Protection and Affordable Care Act 2009
C) National Correct Coding Initiative of 1995
D) HIPAA
Answer: D
Rationale: The Health Insurance Portability and Accountability Act (HIPAA)
includes Title II: Administrative Simplification . This provision focuses on
reducing healthcare administrative costs and burdens through standardized
electronic transactions, privacy, and security procedures.
Q5. Which of the following describes the content of a medical
practice aging report?
A) An overview of the practice's net worth
B) An overview of the practice deposits
C) An overview of the practice's debts
D) An overview of the practice's outstanding claims
Answer: D
Rationale: An aging report provides an overview of the practice's
outstanding claims . It organizes accounts receivable by the length of time a
balance has been outstanding (e.g., 30, 60, 90, 120+ days).
,Q6. What are the possible consequences of inaccurate coding and
incorrect billing? (Select all that apply)
A) Delayed processing and payment of claims
B) Reduced payments or denied claims
C) Fines and imprisonment
D) Exclusion from payer programs
Answer: A, B, C, D
Rationale: All options are potential consequences of inaccurate coding and
incorrect billing . Consequences range from delayed payments to criminal
prosecution, fines, imprisonment, and exclusion from payer programs like
Medicare and Medicaid.
Q7. Under the HIPAA Privacy Rule, when may providers use
Protected Health Information (PHI) without specific patient
authorization?
A) For Treatment, Payment, and Healthcare Operations (TPO)
B) For marketing purposes
C) For sale to third-party vendors
D) For research without IRB approval
Answer: A
Rationale: Under the HIPAA Privacy Rule, providers may use PHI without
specific patient authorization for Treatment, Payment, and Healthcare
Operations (TPO) . This includes activities such as training staff and quality
improvement.
Q8. Which of the following is the correct term for an amount that
has been determined to be uncollectible?
A) Discounted fee
B) Bad debt
C) Financial hardship
D) Professional courtesy
Answer: B
Rationale: Bad debt is the term for an amount that has been determined to
be uncollectible . After reasonable collection efforts have failed, the amount
may be written off as bad debt.
Q9. An employer is legally responsible for their own conduct and for
the actions of employees performed within the context of their
employment. This is called:
, A) Vicarious liability (Respondeat superior)
B) Errors and omissions insurance
C) Compliance regulation
D) Risk management
Answer: A
Rationale: Vicarious liability, also known as "respondeat superior" (let the
master answer), means physicians are legally responsible for their own
conduct and any actions of their employees performed within the context of
their employment .
Q10. Which of the following is an example of a violation of an adult
patient's confidentiality?
A) A CBCS queries the physician about a diagnosis in a patient's medical
record
B) The physician uses his home phone to discuss patient care with the
nursing staff
C) While reviewing a claim, the CBCS reads the diagnosis before
realizing that the patient is a neighbor
D) A provider updates a patient's family on the patient's condition after the
patient has given permission
Answer: C
Rationale: Reading a patient's diagnosis before realizing the patient is a
neighbor is a violation of confidentiality . Even if unintentional, accessing a
patient's information without a legitimate reason is a breach.
Q11. Patient charges that have not been paid will appear in which of
the following?
A) Accounts receivable
B) Accounts payable
C) Tracer
D) Rejected claim
Answer: A
Rationale: Accounts receivable (A/R) represents money owed to the practice
for services already provided but not yet paid . Unpaid patient charges are
recorded in accounts receivable.
Q12. Compliance regulations are primarily based on which of the
following?
