NHA CBCS 2022 QUESTIONS AND ANSWERS| GRADED A
Which of the following describes the reason for a claim rejection because of Medicare ncci edits?
Correct Answer: Improper code combinations
A claim is submitted with a transposed insurance member ID number and returned to the provider.
Which of the following describes the status that should be assigned to the claim by the carrier? Correct
Answer: invalid
Medigap coverage is offered to Medicare beneficiaries by which of the following? Correct Answer:
Private third-party payers
Which of the following provisions ensures that an insureds benefits from all insurance companies do not
exceed 100% of allowable medical expenses? Correct Answer: coordination of benefits
A coroner's autopsy is comprised of what examinations? Correct Answer: Gross examination
Which of the following statements is true regarding the release of patients records? Correct Answer:
Patient access to psychotherapy notes may be restricted
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 components of an explanation of benefits expedites the process of a phone
appeal? Correct Answer: claim control number
On the cms-1500 claim form, blocks 14 through 33 contain information about which of the following?
Correct Answer: The patient's condition and the provider's information
A billing and coding specialist should understand that the financial records source that is generated by a
providers office is called a Correct Answer: Patient ledger account
Which of the following medical terms refers to the sac that causes the heart Correct Answer:
Pericardium
Hipaa transaction standards apply to which of the following entities? Correct Answer: Health care
clearinghouses
All dependents 10 years of age or older are required to have which of the following for tricare? Correct
Answer: Military identification
The standard medical abbreviation ECG refers to a test used to assess which of the following body
systems? Correct Answer: cardiovascular system
Which of the following is an example of a violation of an adult patient confidentiality? Correct Answer:
Patient information was disclosed to the patient's parent without consent
, Claims that are submitted without an NPI number will delay payment to the provider because Correct
Answer: the number is needed to identify the provider
Which of the following sections of the medical record is used to determine the correct evaluation and
management code used for billing and coding? Correct Answer: history and physical
Which of the following actions should be taken if an insurance company denies a service as not
medically necessary? Correct Answer: Appeal the decision with a provider's report
Which of the following is the portion of the account balance the patient must pay after services are
rendered in the annual deductible is met? Correct Answer: coinsurance
Which of the following is the function of the respiratory system? Correct Answer: Oxygenating blood
cells
Which of the following describes a delinquent claim? Correct Answer: The claim is overdue for payment
Which of the following actions should be billing and coding specialist take if he observes a colleague and
on ethical situation? Correct Answer: Report the incident to a supervisor
A participating Blue Cross Blue Shield provider receives an explanation of benefits for a patient account.
The charge amount was $100. Blue Cross Blue Shield allowed $80 and applied $40 to the patient's
annual deductible. Blue Cross Blue Shield paid the balance at 80%. How much should the patient expect
to pay? Correct Answer: $48
Which of the following statements is correct regarding a deductible? Correct Answer: The deductible is
the patient's responsibility
A physician ordered a comprehensive metabolic panel for 70-year-old patient who has Medicare as her
primary insurance. Which of the following forms is required so no she may be responsible for payment?
Correct Answer: Advance beneficiary notice
Which of the following is the purpose of pre-certification? Correct Answer: Verification of coverage
Which of the following claims is submitted and then optically skin by the insurance carrier and converted
to an electronic form? Correct Answer: Paper claim
Which of the following information is required on a patient account record? Correct Answer: Name and
address of guarantor
Which of the following includes procedures in best practices for correct coding? Correct Answer: Coding
compliance plan
A patient who has a primary malignant neoplasm of the lung should be referred to which of the
following specialist? Correct Answer: Pulmonary oncologist
Which of the following describes the reason for a claim rejection because of Medicare ncci edits?
Correct Answer: Improper code combinations
A claim is submitted with a transposed insurance member ID number and returned to the provider.
Which of the following describes the status that should be assigned to the claim by the carrier? Correct
Answer: invalid
Medigap coverage is offered to Medicare beneficiaries by which of the following? Correct Answer:
Private third-party payers
Which of the following provisions ensures that an insureds benefits from all insurance companies do not
exceed 100% of allowable medical expenses? Correct Answer: coordination of benefits
A coroner's autopsy is comprised of what examinations? Correct Answer: Gross examination
Which of the following statements is true regarding the release of patients records? Correct Answer:
Patient access to psychotherapy notes may be restricted
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 components of an explanation of benefits expedites the process of a phone
appeal? Correct Answer: claim control number
On the cms-1500 claim form, blocks 14 through 33 contain information about which of the following?
Correct Answer: The patient's condition and the provider's information
A billing and coding specialist should understand that the financial records source that is generated by a
providers office is called a Correct Answer: Patient ledger account
Which of the following medical terms refers to the sac that causes the heart Correct Answer:
Pericardium
Hipaa transaction standards apply to which of the following entities? Correct Answer: Health care
clearinghouses
All dependents 10 years of age or older are required to have which of the following for tricare? Correct
Answer: Military identification
The standard medical abbreviation ECG refers to a test used to assess which of the following body
systems? Correct Answer: cardiovascular system
Which of the following is an example of a violation of an adult patient confidentiality? Correct Answer:
Patient information was disclosed to the patient's parent without consent
, Claims that are submitted without an NPI number will delay payment to the provider because Correct
Answer: the number is needed to identify the provider
Which of the following sections of the medical record is used to determine the correct evaluation and
management code used for billing and coding? Correct Answer: history and physical
Which of the following actions should be taken if an insurance company denies a service as not
medically necessary? Correct Answer: Appeal the decision with a provider's report
Which of the following is the portion of the account balance the patient must pay after services are
rendered in the annual deductible is met? Correct Answer: coinsurance
Which of the following is the function of the respiratory system? Correct Answer: Oxygenating blood
cells
Which of the following describes a delinquent claim? Correct Answer: The claim is overdue for payment
Which of the following actions should be billing and coding specialist take if he observes a colleague and
on ethical situation? Correct Answer: Report the incident to a supervisor
A participating Blue Cross Blue Shield provider receives an explanation of benefits for a patient account.
The charge amount was $100. Blue Cross Blue Shield allowed $80 and applied $40 to the patient's
annual deductible. Blue Cross Blue Shield paid the balance at 80%. How much should the patient expect
to pay? Correct Answer: $48
Which of the following statements is correct regarding a deductible? Correct Answer: The deductible is
the patient's responsibility
A physician ordered a comprehensive metabolic panel for 70-year-old patient who has Medicare as her
primary insurance. Which of the following forms is required so no she may be responsible for payment?
Correct Answer: Advance beneficiary notice
Which of the following is the purpose of pre-certification? Correct Answer: Verification of coverage
Which of the following claims is submitted and then optically skin by the insurance carrier and converted
to an electronic form? Correct Answer: Paper claim
Which of the following information is required on a patient account record? Correct Answer: Name and
address of guarantor
Which of the following includes procedures in best practices for correct coding? Correct Answer: Coding
compliance plan
A patient who has a primary malignant neoplasm of the lung should be referred to which of the
following specialist? Correct Answer: Pulmonary oncologist
