CBCS Final Practice Test (NHA) 2024/2025 graded A+
A patient's health plan is referred to as the payer of last resort. The patient is covered by
which of the following health plans?
Medicaid
CHAMPA
Medicare
TRICARE - ANSWER: Medicaid
A provider charged $500 to a claim that had an allowable amount of $400. In which of
the following columns should the CBCS apply the non allowed charge?
-Reference column (For notations)
-Description column
-Payment column
-Adjustment column of the credits - ANSWER: Adjustment column of the credits
Which of the following statements is correct regarding a deductible?
-Coinsurance is a type of deductible
-The physician should write off the deductible
-The insurance company pays for the deductible
-The deductible is the patient's responsibility - ANSWER: The deductible is the patient's
responsibility
Which of the following color formats allows optical scanning of the CMS-1500 claim
form?
-Red
-Blue
-Green
-black - ANSWER: red
Ambulatory surgery centers, home health and hospice organizations use the ______.
-CMS-1500 claim form
-UB-04 claim form
-Advance Beneficiary notice
-First report of injury form - ANSWER: UB-04
Claims that are submitted without an NPI number will delay payment to the provider
because ______.
-The number is the patient' id number
-The number is needed to identify the provider
,-Is is used as a claim number
-It is used as a pre authorization number - ANSWER: The number is needed to identify
the provider
Which of the following terms describes when a plan pays 70% of the allowed amount
and the patient pays 30%?
-Coinsurance
-Deductible
-Premium
-copayment - ANSWER: coinsurance
Which of the following indicates a claim should be submitted on paper instead of
electronically?
-The software claims review process indicates the claim is not complete
-The claim needs authorization
-The claim requires an attachment
-The practice management software is non functional. - ANSWER: the claim requires an
attachment
On a remittance advice form, which of the following is responsible for writing off the
difference between the amount billed and the amount allowed by the agreement?
-Provider
-Insurance company
-Patient
-Third party payer - ANSWER: provider
A physician is contracted with an insurance company to accept the amount. The
insurance company allows $80 of a $120 billed amount, and $50 of the deductible has
not been met. How much should the physician write off the patient's account?
-$40
-$15
-$0
-$50 - ANSWER: $40
The unlisted codes can be found in which of the following locations in the CPT manual?
-Appendix L
-Guidelines prior to each section
-End of each body system
-Table of contents - ANSWER: Guidelines prior to each section
Which of the following blocks should the billing and coding specialist complete the CMS
1500 claims form for procedure, services or supplies?
-Block 12
-Block 2
-Block 24D
-Block 24J - ANSWER: Block 24D
,-Block 12 (patient's authorization block
-Block 2 ( patient's name)
-Block 24J ( for the rendering provider)
Which of the following blocks requires the patient's authorization to release medical
information to process a claim?
Block 12
Block 13
Block 27
Block 31 - ANSWER: Block 12
- Block 13 patient authorization for benefits required for third party payer
- Block 27 accepting assignment of benefits
- Block 31 (treating physician)
Which of the following steps would be part of a physician's practice compliance
program?
-HIPAA compliance audit
-Physician recruitment
-Internal monitoring and auditing
-Notice of privacy practice - ANSWER: Internal monitoring and auditing
Behavior plays an important part of being a team player in a medical practice. Which of
the following is an appropriate action for the CBCS to take?
-Reprimanding another staff member during a team meeting for displaying a bad
attitude toward a patient
-Looking in the medical record of a friend who receives services at the office
-Communicating with the front desk staff during a team meeting about missing
information in patient files
-Questioning the nurse about the provider documentation in the medical record -
ANSWER: Communicating with the front desk staff during a team meeting about
missing information in patient files
Which of the following acts applies to the administrative simplification guideline?
-HIPAA
-Deficit reduction act of 2005
-The patient protection and affordable care act 2009
-National correct coding initiative of 1995 - ANSWER: HIPAA
Which of the following is an example of a violation of an adult patient's confidentiality?
-While reviewing a claim, the CBCS reads the diagnosis before realizing that the patient
is a neighbor
-A CBCS queries the physician about a diagnosis in a patient's medical record
-The physician uses his home phone to discuss patient care with the nursing staff
-Patient information was disclosed to the patient's parents without consent - ANSWER:
Patient information was disclosed to the patient's parents without consent
, Which of the following is the purpose of running an aging report each month?
-If indicates the balances the patients owe the provider
-It indicates which patients have upcoming or missed appointment
-It indicates which claims are outstanding
-It indicates what the insurance company has paid for the provider's services to a
patient. - ANSWER: It indicates which claims are outstanding
Which of the following describes the status of a claim that does not include the required
preauthorization for a service?
-Delinquent (overdue)
-Denied
-Suspended
-Adjudicated (claim still being processed) - ANSWER: Denied
-Delinquent (overdue)
-Adjudicated (claim still being processed)
Which of the following actions should the CBCS take to prevent fraud and abuse in the
medical office?
-Serviced procedure preauthorization
-Internal monitoring and auditing
-Utilization review
-Correct coding initiative - ANSWER: Internal monitoring and auditing
In an outpatient setting, which of the following forms is used as a financial report of all
services provided to patients?
-Encounter form
-Patient account record
-CMS-1500 claim form
-Accounts receivable journal - ANSWER: Patient account record (patient ledger, all
transactions between patient and the practice)
-Accounts receivable journal (Day sheet = chronological summary of all transaction on a
specific day)
Patient charges that have not been paid will appear in which of the following?
-Accounts receivable
-Accounts payable
-Tracer
-Rejected claim - ANSWER: Accounts receivable
Which of the following is considered the final determination of the issues involving
settlement of an insurance claim?
-Processing
-Translation
-Adjudication
-Transmission - ANSWER: Adjudication (process of putting a claim through a series of
edits for final determination)
A patient's health plan is referred to as the payer of last resort. The patient is covered by
which of the following health plans?
Medicaid
CHAMPA
Medicare
TRICARE - ANSWER: Medicaid
A provider charged $500 to a claim that had an allowable amount of $400. In which of
the following columns should the CBCS apply the non allowed charge?
-Reference column (For notations)
-Description column
-Payment column
-Adjustment column of the credits - ANSWER: Adjustment column of the credits
Which of the following statements is correct regarding a deductible?
-Coinsurance is a type of deductible
-The physician should write off the deductible
-The insurance company pays for the deductible
-The deductible is the patient's responsibility - ANSWER: The deductible is the patient's
responsibility
Which of the following color formats allows optical scanning of the CMS-1500 claim
form?
-Red
-Blue
-Green
-black - ANSWER: red
Ambulatory surgery centers, home health and hospice organizations use the ______.
-CMS-1500 claim form
-UB-04 claim form
-Advance Beneficiary notice
-First report of injury form - ANSWER: UB-04
Claims that are submitted without an NPI number will delay payment to the provider
because ______.
-The number is the patient' id number
-The number is needed to identify the provider
,-Is is used as a claim number
-It is used as a pre authorization number - ANSWER: The number is needed to identify
the provider
Which of the following terms describes when a plan pays 70% of the allowed amount
and the patient pays 30%?
-Coinsurance
-Deductible
-Premium
-copayment - ANSWER: coinsurance
Which of the following indicates a claim should be submitted on paper instead of
electronically?
-The software claims review process indicates the claim is not complete
-The claim needs authorization
-The claim requires an attachment
-The practice management software is non functional. - ANSWER: the claim requires an
attachment
On a remittance advice form, which of the following is responsible for writing off the
difference between the amount billed and the amount allowed by the agreement?
-Provider
-Insurance company
-Patient
-Third party payer - ANSWER: provider
A physician is contracted with an insurance company to accept the amount. The
insurance company allows $80 of a $120 billed amount, and $50 of the deductible has
not been met. How much should the physician write off the patient's account?
-$40
-$15
-$0
-$50 - ANSWER: $40
The unlisted codes can be found in which of the following locations in the CPT manual?
-Appendix L
-Guidelines prior to each section
-End of each body system
-Table of contents - ANSWER: Guidelines prior to each section
Which of the following blocks should the billing and coding specialist complete the CMS
1500 claims form for procedure, services or supplies?
-Block 12
-Block 2
-Block 24D
-Block 24J - ANSWER: Block 24D
,-Block 12 (patient's authorization block
-Block 2 ( patient's name)
-Block 24J ( for the rendering provider)
Which of the following blocks requires the patient's authorization to release medical
information to process a claim?
Block 12
Block 13
Block 27
Block 31 - ANSWER: Block 12
- Block 13 patient authorization for benefits required for third party payer
- Block 27 accepting assignment of benefits
- Block 31 (treating physician)
Which of the following steps would be part of a physician's practice compliance
program?
-HIPAA compliance audit
-Physician recruitment
-Internal monitoring and auditing
-Notice of privacy practice - ANSWER: Internal monitoring and auditing
Behavior plays an important part of being a team player in a medical practice. Which of
the following is an appropriate action for the CBCS to take?
-Reprimanding another staff member during a team meeting for displaying a bad
attitude toward a patient
-Looking in the medical record of a friend who receives services at the office
-Communicating with the front desk staff during a team meeting about missing
information in patient files
-Questioning the nurse about the provider documentation in the medical record -
ANSWER: Communicating with the front desk staff during a team meeting about
missing information in patient files
Which of the following acts applies to the administrative simplification guideline?
-HIPAA
-Deficit reduction act of 2005
-The patient protection and affordable care act 2009
-National correct coding initiative of 1995 - ANSWER: HIPAA
Which of the following is an example of a violation of an adult patient's confidentiality?
-While reviewing a claim, the CBCS reads the diagnosis before realizing that the patient
is a neighbor
-A CBCS queries the physician about a diagnosis in a patient's medical record
-The physician uses his home phone to discuss patient care with the nursing staff
-Patient information was disclosed to the patient's parents without consent - ANSWER:
Patient information was disclosed to the patient's parents without consent
, Which of the following is the purpose of running an aging report each month?
-If indicates the balances the patients owe the provider
-It indicates which patients have upcoming or missed appointment
-It indicates which claims are outstanding
-It indicates what the insurance company has paid for the provider's services to a
patient. - ANSWER: It indicates which claims are outstanding
Which of the following describes the status of a claim that does not include the required
preauthorization for a service?
-Delinquent (overdue)
-Denied
-Suspended
-Adjudicated (claim still being processed) - ANSWER: Denied
-Delinquent (overdue)
-Adjudicated (claim still being processed)
Which of the following actions should the CBCS take to prevent fraud and abuse in the
medical office?
-Serviced procedure preauthorization
-Internal monitoring and auditing
-Utilization review
-Correct coding initiative - ANSWER: Internal monitoring and auditing
In an outpatient setting, which of the following forms is used as a financial report of all
services provided to patients?
-Encounter form
-Patient account record
-CMS-1500 claim form
-Accounts receivable journal - ANSWER: Patient account record (patient ledger, all
transactions between patient and the practice)
-Accounts receivable journal (Day sheet = chronological summary of all transaction on a
specific day)
Patient charges that have not been paid will appear in which of the following?
-Accounts receivable
-Accounts payable
-Tracer
-Rejected claim - ANSWER: Accounts receivable
Which of the following is considered the final determination of the issues involving
settlement of an insurance claim?
-Processing
-Translation
-Adjudication
-Transmission - ANSWER: Adjudication (process of putting a claim through a series of
edits for final determination)
