NHA CBCS EXAM REVIEW QUESTIONS AND
ANSWERS WITH COMPLETE SOLUTION RATED A
Which of the following Medicare policies determines if a particular item or service is covered by
Medicare? Correct 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? Correct Answer: Denied
A billing and coding specialist should routinely analyze which of the following to determine the number
of outstanding claims? Correct Answer: Aging report
Which of the following should a billing and coding specialist use to submit a claim with supporting
documents? Correct 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? Correct 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? Correct 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? Correct Answer: Send the medical information pertaining to the dates of service
requested
Which of the following is the deadline for Medicare claim submission? Correct Answer: 12 months from
the date of service
Which of the following forms does a third-party payer require for physician services? Correct 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? Correct 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? Correct
Answer: Adjustment
Which of the following HMO managed care services requires a referral? Correct Answer: Durable
medical equipment
Which of the following explains why Medicare will deny a particular service or procedure? Correct
Answer: Advance Beneficiary Notice (ABN)
Which of the following types of claims is 120 days old? Correct 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? Correct 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? Correct Answer:
The wife's insurance
Which of the following would most likely result in a denial on a Medicare claim? Correct 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? Correct 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? Correct
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? Correct 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? Correct 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? Correct 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? Correct Answer: Angioplasty
Which of the following actions by a billing and coding specialist would be considered fraud? Correct
Answer: Billing for services not provided
Which of the following statements is accurate regarding the diagnostic codes in Block 21? Correct
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? Correct 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? Correct 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.
ANSWERS WITH COMPLETE SOLUTION RATED A
Which of the following Medicare policies determines if a particular item or service is covered by
Medicare? Correct 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? Correct Answer: Denied
A billing and coding specialist should routinely analyze which of the following to determine the number
of outstanding claims? Correct Answer: Aging report
Which of the following should a billing and coding specialist use to submit a claim with supporting
documents? Correct 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? Correct 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? Correct 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? Correct Answer: Send the medical information pertaining to the dates of service
requested
Which of the following is the deadline for Medicare claim submission? Correct Answer: 12 months from
the date of service
Which of the following forms does a third-party payer require for physician services? Correct 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? Correct 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? Correct
Answer: Adjustment
Which of the following HMO managed care services requires a referral? Correct Answer: Durable
medical equipment
Which of the following explains why Medicare will deny a particular service or procedure? Correct
Answer: Advance Beneficiary Notice (ABN)
Which of the following types of claims is 120 days old? Correct 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? Correct 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? Correct Answer:
The wife's insurance
Which of the following would most likely result in a denial on a Medicare claim? Correct 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? Correct 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? Correct
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? Correct 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? Correct 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? Correct 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? Correct Answer: Angioplasty
Which of the following actions by a billing and coding specialist would be considered fraud? Correct
Answer: Billing for services not provided
Which of the following statements is accurate regarding the diagnostic codes in Block 21? Correct
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? Correct 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? Correct 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.
