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