NHA CBCS 2024/2025 COMPREHENSIVE QUESTIONS
AND CORRECT ANSWERS GET ALL RIGHT [EXAM
PREPARATION] GRADE A+
Which of the following entities works with Centers for Medicare and
Medicaid services to prevent over payment
Medicaid Integrity
contractors
Which of the following actions by a billing and coding specialist is
insurance abuse
Using a health insurance identification
number other than the patients to ensure payments
Which of the following refers to payers electronically transferring date
in order to facilitate coordination of benefits on a clean claim
Crossover
Which of the following is responsible for the health care of its
policyhold- ers and identifies health insurance, facilities, providers, or
health systems?
Managed care Organization
What act mandated the reporting of ICD-9-CM diagnosis codes?
The Medicare Catastrophic Coverage Act of 1988
Electronic Data interchange (EDI)
Transmitting electronic medical insurance claims from providers to payers using the necessary
information systems is called
Medical Ethics are
Standards of conduct based on moral principals. Acting within ethical behavior boundries means
carrying out one's responsibilities with integrity, decency, respect, honesty, competence, fairness and
trust.
Three Components for E*M Codes
1.History
2.Physical Exam
3.Medical Decision-Making
Guidelines are Found?
At the beginning of each section and used to provide specific coding rules for that section.
,Co-payment
A fixed fee collected at the time of the patients visit.
Review Linkage Protocol
Appropriateness of Codes, Payers rules about linkage, Documentation to support codes, Compliance
with regulation and guidelines
What is confidentiality?
Involves restricting patient information access to those with proper authorization and maintaining the
security of patient information.
E Codes
For durable medical equipment for use in home
Chief Complaint (CC)
The reason the patient came to see the physician.
Past, Family and Social History (PFSH)
Consists of patients personal experiences with illnesses, surgeries, and injuries; Information of illnesses
predominant in family; Patients educational background, occupation, marital status and other factors
Add on Codes
Used for procedures that are always performed during the same operative session, as another surgery in
addition to the primary service/procedure and is never performed separately.
What are the names of the three tables that appear in the Index to Diseases?
Hypertension Neoplasm Table of Drugs and Chemicals
Level 2 codes
National codes for physician and non-physician service not found in the CPT Level 1
Inpatient
A/An ___________ is a person admitted to a hospital or long-term care facility(LTCF) for treatment with
the expectation that the patient will remain in the hospital for a period of 24 hours or more.
HIPAA is an acronym for
Health Insurance Portability and Accountability Act of 1996.
Life Cycle of a Claim
Submission, Processing, Adjudication, Non-covered, Unauthorized, Medical Necessity Checks, Payment /
RA / ERA
Level 1 codes
, Codes found in the CPT manual
Deductible
The out-of-pocket payment amount that a policyholder must meet before insurance covers the
service(s) is called?
Coinsurance
A fixed percentage of covered charges applied to the patients bill after the deductible has been met.
Liability Insurance
Covers injuries caused by insured that occurred on the insured's property.
Unspecified
"No notation of benign or malignant status is found in the diagnosis or in the patient's chart."
subpoena
A writ requiring the appearance of a person at a trial or other proceeding is a ___________.
Medicare
What is the single largest healthcare program in the United States?
Parentheses
Used to enclose supplementary words; non essential modifiers
Indemnity insurance
Health indemnity insurance is a fee for service insurance that is sometimes used when a person is in
between health plans, and will cover some (but not all) expenses
Rejected Claim
A rejected claim is an electronically submitted claim that is unprocessable due to missing or invalid
information required by the payer.
77010 - 79999
Radiology
Medicaid Medically Needy
provide Medicaid to certain groups not otherwise eligible for Medicaid.must cover:
•Pregnant women:
•Children under 18:
•States have option to cover:
•Children up to 21:
•Parents and other caretaker
relatives:
AND CORRECT ANSWERS GET ALL RIGHT [EXAM
PREPARATION] GRADE A+
Which of the following entities works with Centers for Medicare and
Medicaid services to prevent over payment
Medicaid Integrity
contractors
Which of the following actions by a billing and coding specialist is
insurance abuse
Using a health insurance identification
number other than the patients to ensure payments
Which of the following refers to payers electronically transferring date
in order to facilitate coordination of benefits on a clean claim
Crossover
Which of the following is responsible for the health care of its
policyhold- ers and identifies health insurance, facilities, providers, or
health systems?
Managed care Organization
What act mandated the reporting of ICD-9-CM diagnosis codes?
The Medicare Catastrophic Coverage Act of 1988
Electronic Data interchange (EDI)
Transmitting electronic medical insurance claims from providers to payers using the necessary
information systems is called
Medical Ethics are
Standards of conduct based on moral principals. Acting within ethical behavior boundries means
carrying out one's responsibilities with integrity, decency, respect, honesty, competence, fairness and
trust.
Three Components for E*M Codes
1.History
2.Physical Exam
3.Medical Decision-Making
Guidelines are Found?
At the beginning of each section and used to provide specific coding rules for that section.
,Co-payment
A fixed fee collected at the time of the patients visit.
Review Linkage Protocol
Appropriateness of Codes, Payers rules about linkage, Documentation to support codes, Compliance
with regulation and guidelines
What is confidentiality?
Involves restricting patient information access to those with proper authorization and maintaining the
security of patient information.
E Codes
For durable medical equipment for use in home
Chief Complaint (CC)
The reason the patient came to see the physician.
Past, Family and Social History (PFSH)
Consists of patients personal experiences with illnesses, surgeries, and injuries; Information of illnesses
predominant in family; Patients educational background, occupation, marital status and other factors
Add on Codes
Used for procedures that are always performed during the same operative session, as another surgery in
addition to the primary service/procedure and is never performed separately.
What are the names of the three tables that appear in the Index to Diseases?
Hypertension Neoplasm Table of Drugs and Chemicals
Level 2 codes
National codes for physician and non-physician service not found in the CPT Level 1
Inpatient
A/An ___________ is a person admitted to a hospital or long-term care facility(LTCF) for treatment with
the expectation that the patient will remain in the hospital for a period of 24 hours or more.
HIPAA is an acronym for
Health Insurance Portability and Accountability Act of 1996.
Life Cycle of a Claim
Submission, Processing, Adjudication, Non-covered, Unauthorized, Medical Necessity Checks, Payment /
RA / ERA
Level 1 codes
, Codes found in the CPT manual
Deductible
The out-of-pocket payment amount that a policyholder must meet before insurance covers the
service(s) is called?
Coinsurance
A fixed percentage of covered charges applied to the patients bill after the deductible has been met.
Liability Insurance
Covers injuries caused by insured that occurred on the insured's property.
Unspecified
"No notation of benign or malignant status is found in the diagnosis or in the patient's chart."
subpoena
A writ requiring the appearance of a person at a trial or other proceeding is a ___________.
Medicare
What is the single largest healthcare program in the United States?
Parentheses
Used to enclose supplementary words; non essential modifiers
Indemnity insurance
Health indemnity insurance is a fee for service insurance that is sometimes used when a person is in
between health plans, and will cover some (but not all) expenses
Rejected Claim
A rejected claim is an electronically submitted claim that is unprocessable due to missing or invalid
information required by the payer.
77010 - 79999
Radiology
Medicaid Medically Needy
provide Medicaid to certain groups not otherwise eligible for Medicaid.must cover:
•Pregnant women:
•Children under 18:
•States have option to cover:
•Children up to 21:
•Parents and other caretaker
relatives:
