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.
