NHA - Certified Billing and Coding Specialist (CBCS) Study Guide
The symbol "O" in the Current Procedural Terminology reference is used to indicate what? -
CORRECT ANSWER: Reinstated or recycled code
In the anesthesia section of the CPT manual, what are considered qualifying circumstances? -
CORRECT ANSWER: Add-on codes
As of April 1, 2014 what is the maximum number of diagnoses that can be reported on the CMS-
1500 claim form before a further claim is required? - CORRECT ANSWER: 12
What is considered proper supportive documentation for reporting CPT and ICD codes for
surgical procedures? - CORRECT ANSWER: Operative report
What action should be taken first when reviewing a delinquent claim? - CORRECT ANSWER:
Verify the age of the account
A claim can be denied or rejected for which of the following reasons? - CORRECT ANSWER:
Block 24D contains the diagnosis code
A coroner's autopsy is comprised of what examinations? - CORRECT ANSWER: Gross
Examination
Medigap coverage is offered to Medicare beneficiaries by whom? - CORRECT ANSWER:
Private third-party payers
What part of Medicare covers prescriptions? - CORRECT ANSWER: Part C
What plane divides the body into left and right? - CORRECT ANSWER: Sagittal
Where can unlisted codes be found in the CPT manual? - CORRECT ANSWER: Guidelines
prior to each section
Ambulatory surgery centers, home health care, and hospice organizations use which form to
submit claims? - CORRECT ANSWER: UB-04 Claim Form
What color format is acceptable on the CMS-1500 claim form? - CORRECT ANSWER: Red
Who is responsible to pay the deductible? - CORRECT ANSWER: Patient
A patient's health plan is referred to as the "payer of last resort." What is the name of that health
plan? - CORRECT ANSWER: Medicaid
Informed Consent - CORRECT ANSWER: Providers explain medical or diagnostic procedures,
surgical interventions, and the benefits and risks involved, giving patients an opportunity to ask
questions before medical intervention is provided.
Implied Consent - CORRECT ANSWER: A patient presents for treatment, such as extending an
arm to allow a venipuncture to be performed.
, Clearinghouse - CORRECT ANSWER: Agency that converts claims into standardized electronic
format, looks for errors, and formats them according to HIPAA and insurance standards.
Individually Identifiable - CORRECT ANSWER: Documents that identify the person or provide
enough information so that the person can be identified.
De-identified Information - CORRECT ANSWER: Information that does not identify an
individual because unique and personal characteristics have been removed.
Consent - CORRECT ANSWER: A patient's permission evidenced by signature.
Authorizations - CORRECT ANSWER: Permission granted by the patient or the patient's
representative to release information for reasons other than treatment, payment, or health care
operations.
Reimbursement - CORRECT ANSWER: Payment for services rendered from a third-party
payer.
Auditing - CORRECT ANSWER: Review of claims for accuracy and completeness.
Fraud - CORRECT ANSWER: Making false statements of representations of material facts to
obtain some benefit or payment for which no entitlement would otherwise exist.
Upcoding - CORRECT ANSWER: Assigning a diagnosis or procedure code at a higher level
than the documentation supports, such as coding bronchitis as pneumonia.
Unbundling - CORRECT ANSWER: Using multiple codes that describe different components of
a treatment instead of using a single code that describes all steps of the procedure.
Abuse - CORRECT ANSWER: Practices that directly or indirectly result in unnecessary costs to
the Medicare program.
Business Associate (BA) - CORRECT ANSWER: Individuals, groups, or organizations who are
not members of a covered entity's workforce that perform functions or activities on behalf of or
for a covered entity.
What is the main job of the Office of the Inspector General (OIG)? - CORRECT ANSWER: The
OIG protects Medicare and other HHS programs from fraud and abuse by conducting audits,
investigations , and inspections.
Medicare - CORRECT ANSWER: Federally funded health insurance provided to people age 65
or older, and people 65 and younger with certain disabilities.
Medicaid - CORRECT ANSWER: A government-based health insurance option that pays for
medical assistance for individuals who have low incomes and limited financial resources.
Timely Filing Requirements - CORRECT ANSWER: Within 1 calendar year of a claim's date of
service.
The symbol "O" in the Current Procedural Terminology reference is used to indicate what? -
CORRECT ANSWER: Reinstated or recycled code
In the anesthesia section of the CPT manual, what are considered qualifying circumstances? -
CORRECT ANSWER: Add-on codes
As of April 1, 2014 what is the maximum number of diagnoses that can be reported on the CMS-
1500 claim form before a further claim is required? - CORRECT ANSWER: 12
What is considered proper supportive documentation for reporting CPT and ICD codes for
surgical procedures? - CORRECT ANSWER: Operative report
What action should be taken first when reviewing a delinquent claim? - CORRECT ANSWER:
Verify the age of the account
A claim can be denied or rejected for which of the following reasons? - CORRECT ANSWER:
Block 24D contains the diagnosis code
A coroner's autopsy is comprised of what examinations? - CORRECT ANSWER: Gross
Examination
Medigap coverage is offered to Medicare beneficiaries by whom? - CORRECT ANSWER:
Private third-party payers
What part of Medicare covers prescriptions? - CORRECT ANSWER: Part C
What plane divides the body into left and right? - CORRECT ANSWER: Sagittal
Where can unlisted codes be found in the CPT manual? - CORRECT ANSWER: Guidelines
prior to each section
Ambulatory surgery centers, home health care, and hospice organizations use which form to
submit claims? - CORRECT ANSWER: UB-04 Claim Form
What color format is acceptable on the CMS-1500 claim form? - CORRECT ANSWER: Red
Who is responsible to pay the deductible? - CORRECT ANSWER: Patient
A patient's health plan is referred to as the "payer of last resort." What is the name of that health
plan? - CORRECT ANSWER: Medicaid
Informed Consent - CORRECT ANSWER: Providers explain medical or diagnostic procedures,
surgical interventions, and the benefits and risks involved, giving patients an opportunity to ask
questions before medical intervention is provided.
Implied Consent - CORRECT ANSWER: A patient presents for treatment, such as extending an
arm to allow a venipuncture to be performed.
, Clearinghouse - CORRECT ANSWER: Agency that converts claims into standardized electronic
format, looks for errors, and formats them according to HIPAA and insurance standards.
Individually Identifiable - CORRECT ANSWER: Documents that identify the person or provide
enough information so that the person can be identified.
De-identified Information - CORRECT ANSWER: Information that does not identify an
individual because unique and personal characteristics have been removed.
Consent - CORRECT ANSWER: A patient's permission evidenced by signature.
Authorizations - CORRECT ANSWER: Permission granted by the patient or the patient's
representative to release information for reasons other than treatment, payment, or health care
operations.
Reimbursement - CORRECT ANSWER: Payment for services rendered from a third-party
payer.
Auditing - CORRECT ANSWER: Review of claims for accuracy and completeness.
Fraud - CORRECT ANSWER: Making false statements of representations of material facts to
obtain some benefit or payment for which no entitlement would otherwise exist.
Upcoding - CORRECT ANSWER: Assigning a diagnosis or procedure code at a higher level
than the documentation supports, such as coding bronchitis as pneumonia.
Unbundling - CORRECT ANSWER: Using multiple codes that describe different components of
a treatment instead of using a single code that describes all steps of the procedure.
Abuse - CORRECT ANSWER: Practices that directly or indirectly result in unnecessary costs to
the Medicare program.
Business Associate (BA) - CORRECT ANSWER: Individuals, groups, or organizations who are
not members of a covered entity's workforce that perform functions or activities on behalf of or
for a covered entity.
What is the main job of the Office of the Inspector General (OIG)? - CORRECT ANSWER: The
OIG protects Medicare and other HHS programs from fraud and abuse by conducting audits,
investigations , and inspections.
Medicare - CORRECT ANSWER: Federally funded health insurance provided to people age 65
or older, and people 65 and younger with certain disabilities.
Medicaid - CORRECT ANSWER: A government-based health insurance option that pays for
medical assistance for individuals who have low incomes and limited financial resources.
Timely Filing Requirements - CORRECT ANSWER: Within 1 calendar year of a claim's date of
service.
