NHA CBCS EXAM REVIEW 2021-2022.
Which of the following Medicare policies determines if a particular item or service is covered by
Medicare?
✅Answer- National Coverage Determination (NCD)
A patient's employer has not submitted a premium payment. Which of the following claim statuses
should the provider receive from the third-party payer?
✅Answer- Denied
A billing and coding specialist should routinely analyze which of the following to determine the number
of outstanding claims?
✅Answer- Aging report
Which of the following should a billing and coding specialist use to submit a claim with supporting
documents?
✅Answer- Claims attachment
Which of the following terms is used to communicate why a claim line item was denied or paid
differently than it was billing?
✅Answer- Claim adjustment codes
On a CMS-1500 claim form, which of the following information should the billing and coding specialist
enter into Block 32?
✅Answer- Service facility location information
A provider's office receives a subpoena requesting medical documentation from a patient's medical
record. After confirming the correct authorization, which of the following actions should the billing and
coding specialist take?
✅Answer- Send the medical information pertaining to the dates of service requested
Which of the following is the deadline for Medicare claim submission?
✅Answer- 12 months from the date of service
Which of the following forms does a third-party payer require for physician services?
✅Answer- CMS-1500
A patient who is an active member of the military recently returned from overseas and is in need of
specialty care. The patient does not have anyone designed with power of attorney. Which of the
following is considered a HIPAA violation?
,✅Answer- The billing and coding specialist sends the patient's records to the patient's partner.
Which of the following terms refers to the difference between the billing and allowed amounts?
✅Answer- Adjustment
Which of the following HMO managed care services requires a referral?
✅Answer- Durable medical equipment
Which of the following explains why Medicare will deny a particular service or procedure?
✅Answer- Advance Beneficiary Notice (ABN)
Which of the following types of claims is 120 days old?
✅Answer- Delinquent
When reviewing an established patient's insurance card, the billing and coding specialist notices a minor
change from the existing card on file. Which of the following actions should the billing and coding
specialist take?
✅Answer- Photocopy both sides of the new card
A husband and wife each have group insurance through their employers. The wife has an appointment
with her provider. Which insurance should be used as primary for the appointment?
✅Answer- The wife's insurance
Which of the following would most likely result in a denial on a Medicare claim?
✅Answer- An experimental chemotherapy medication for a patient who has stage III renal cancer
Which of the following pieces of guarantor information is required when establishing a patient's
financial record?
✅Answer- Phone number
A provider surgically punctures through the space between the patient's ribs using an aspirating needle
to withdraw fluid from the chest cavity. Which of the following is the name of this procedure?
✅Answer- Pleurocentesis
A patient has AARP as secondary insurance. In which of the following blocks on the CMS-1500 claim
form should the information be entered?
✅Answer- Block 9
, A Medicare non-participating (non-PAR) provider's approved payment amount is $200 for a lobectomy
and the deductible has been met. Which of the following amounts is the limiting charge for this
procedure? ✅Answer- $230
**A non-PAR who does not accept assignment, can collect a maximum of 15% (the limiting charge) over
the non-PAR Medicare fee schedule amount.
In the anesthesia section of the CPT manual, which of the following are considered qualifying
circumstances?
✅Answer- Add-on codes
Threading a catheter with a balloon into a coronary artery and expanding it to repair arteries describes
which of the following procedures?
✅Answer- Angioplasty
Which of the following actions by a billing and coding specialist would be considered fraud?
✅Answer- Billing for services not provided
Which of the following statements is accurate regarding the diagnostic codes in Block 21?
✅Answer- These codes must correspond to the diagnosis pointer in Block 24E
Which of the following parts of the Medicare insurance program is managed by private, third-party
insurance providers that have been approved by Medicare?
✅Answer- Medicare Part C
A billing and coding specialist can ensure appropriate insurance coverage for an outpatient procedure by
first using which of the following processes?
✅Answer- Precertification
**Precertification is the first step. Preauthorization is a decision from the payer to approve the service.
It is not the first step to determine insurance reimbursement.
Which of the following is considered fraud?
✅Answer- The billing and coding specialist unbundles a code to receive higher reimbursement
The authorization number for a service that was approved before the service was rendered is indicated
in which of the following blocks on the CMS-1500 claim form?
✅Answer- Block 23
A patient is preauthorized to receive vitamin B12 injections from Jan 1 to May 31. On June 2, the
provider orders an additional 6 months of injections. In order for the patient to continue with coverage
of care, which of the following should occur?
✅Answer- The provider should contact the patient's insurance carrier to obtain a new authorization
Which of the following Medicare policies determines if a particular item or service is covered by
Medicare?
✅Answer- National Coverage Determination (NCD)
A patient's employer has not submitted a premium payment. Which of the following claim statuses
should the provider receive from the third-party payer?
✅Answer- Denied
A billing and coding specialist should routinely analyze which of the following to determine the number
of outstanding claims?
✅Answer- Aging report
Which of the following should a billing and coding specialist use to submit a claim with supporting
documents?
✅Answer- Claims attachment
Which of the following terms is used to communicate why a claim line item was denied or paid
differently than it was billing?
✅Answer- Claim adjustment codes
On a CMS-1500 claim form, which of the following information should the billing and coding specialist
enter into Block 32?
✅Answer- Service facility location information
A provider's office receives a subpoena requesting medical documentation from a patient's medical
record. After confirming the correct authorization, which of the following actions should the billing and
coding specialist take?
✅Answer- Send the medical information pertaining to the dates of service requested
Which of the following is the deadline for Medicare claim submission?
✅Answer- 12 months from the date of service
Which of the following forms does a third-party payer require for physician services?
✅Answer- CMS-1500
A patient who is an active member of the military recently returned from overseas and is in need of
specialty care. The patient does not have anyone designed with power of attorney. Which of the
following is considered a HIPAA violation?
,✅Answer- The billing and coding specialist sends the patient's records to the patient's partner.
Which of the following terms refers to the difference between the billing and allowed amounts?
✅Answer- Adjustment
Which of the following HMO managed care services requires a referral?
✅Answer- Durable medical equipment
Which of the following explains why Medicare will deny a particular service or procedure?
✅Answer- Advance Beneficiary Notice (ABN)
Which of the following types of claims is 120 days old?
✅Answer- Delinquent
When reviewing an established patient's insurance card, the billing and coding specialist notices a minor
change from the existing card on file. Which of the following actions should the billing and coding
specialist take?
✅Answer- Photocopy both sides of the new card
A husband and wife each have group insurance through their employers. The wife has an appointment
with her provider. Which insurance should be used as primary for the appointment?
✅Answer- The wife's insurance
Which of the following would most likely result in a denial on a Medicare claim?
✅Answer- An experimental chemotherapy medication for a patient who has stage III renal cancer
Which of the following pieces of guarantor information is required when establishing a patient's
financial record?
✅Answer- Phone number
A provider surgically punctures through the space between the patient's ribs using an aspirating needle
to withdraw fluid from the chest cavity. Which of the following is the name of this procedure?
✅Answer- Pleurocentesis
A patient has AARP as secondary insurance. In which of the following blocks on the CMS-1500 claim
form should the information be entered?
✅Answer- Block 9
, A Medicare non-participating (non-PAR) provider's approved payment amount is $200 for a lobectomy
and the deductible has been met. Which of the following amounts is the limiting charge for this
procedure? ✅Answer- $230
**A non-PAR who does not accept assignment, can collect a maximum of 15% (the limiting charge) over
the non-PAR Medicare fee schedule amount.
In the anesthesia section of the CPT manual, which of the following are considered qualifying
circumstances?
✅Answer- Add-on codes
Threading a catheter with a balloon into a coronary artery and expanding it to repair arteries describes
which of the following procedures?
✅Answer- Angioplasty
Which of the following actions by a billing and coding specialist would be considered fraud?
✅Answer- Billing for services not provided
Which of the following statements is accurate regarding the diagnostic codes in Block 21?
✅Answer- These codes must correspond to the diagnosis pointer in Block 24E
Which of the following parts of the Medicare insurance program is managed by private, third-party
insurance providers that have been approved by Medicare?
✅Answer- Medicare Part C
A billing and coding specialist can ensure appropriate insurance coverage for an outpatient procedure by
first using which of the following processes?
✅Answer- Precertification
**Precertification is the first step. Preauthorization is a decision from the payer to approve the service.
It is not the first step to determine insurance reimbursement.
Which of the following is considered fraud?
✅Answer- The billing and coding specialist unbundles a code to receive higher reimbursement
The authorization number for a service that was approved before the service was rendered is indicated
in which of the following blocks on the CMS-1500 claim form?
✅Answer- Block 23
A patient is preauthorized to receive vitamin B12 injections from Jan 1 to May 31. On June 2, the
provider orders an additional 6 months of injections. In order for the patient to continue with coverage
of care, which of the following should occur?
✅Answer- The provider should contact the patient's insurance carrier to obtain a new authorization
