CBCS Final Practice Test (NHA)
which of the following is a key protection standard of the HIPAA privacy rule that
requires entities and business associates to limit the use or release of protected health
information phi)? - ANSWER: minimum necessary
A billing and coding specialist is preparing a claim that includes code A9698. Which of
the following actions should the specialist take to ensure the claim will be paid the first
time it is submitted? - ANSWER: append the appropriate physical status modifier to the
code
Which of the following describes the status of a claim that is in process and does not
include required preauthorization for a service? - ANSWER: suspended
A third-party payer requests a patients information related to a claim. A billing and
coding specialist should ensure that which of the following is included in the patients file
before providing the information? - ANSWER: signed release of information form
A lightning bolt symbol that precedes a code indicates which of the following? -
ANSWER: code indicates a service is pending FDA approval
A billing and coding specialist is using an accounts receivable aging report to determine
which accounts should be sent to collection. According to best practice, which of the
following accounts should the specialist send to collections? - ANSWER: An account
that has a balance of $600 and 135 days old.
Which of the following CPT codes should a billing and coding specialist use to indicate a
total prostate specific antigen (PSA) test? - ANSWER: 84153
Which of the following is the purpose of a claims clearinghouse? - ANSWER: To identify
errors that will prevent a claim from being paid
Which of the following describes a claim that is 120 days old? - ANSWER: delinquent
Which of the following plans requires providers to adhere to managed care provisions? -
ANSWER: health maintenance organization (HMO) plan
According to the ICD-10-CM coding guidelines, the fourth character of an ICD-10-CM
diagnosis code indicates which of the following? - ANSWER: anatomic site
Which of the following codes are used to code diseases, injuries, impairments, and
other health-related problems? - ANSWER: ICD-10-CM codes
, An internal retrospective billing account audit prevents fraud and abuse by reviewing
and comparing completed claim forms with which of the following? - ANSWER:
Documentation of compliance plans
which of the following types of insurance do health care professionals purchase to
protect themselves from liability relating to claims arising from patient treatments? -
ANSWER: medical malpractice
A new patient is seen in the office for frequent urination and excessive thirst. The
provider performs a detailed history and examination. Which of the following coding
manual should a billing and coding specialist reference to determine the Evaluation and
Management (E/M) level of care for the visit? - ANSWER: CPT
A billing and coding specialist should consider which of the following when determining
an evaluation and management (E/M) code. - ANSWER: place of service
A billing and coding specialist is a preparing a claim for a patient who had an Evaluation
and Management (E/M) visit for abdominal pain that resulted in the decision to remove
the appendix immediately. Which of the following modifier should use for this claim? -
ANSWER: 25 modifier
patient who has a past due balance requests their records be sent to another provider.
Which of the following actions should the billing and coding specialist take with regards
to the records request? - ANSWER: Begin collection action on the balance due.
After a third-party payer validates a claim, which of the following takes place next? -
ANSWER: Claim adjudication
How many days after receipt of an initial demand letter from a Medicare administrative
contractor (MAC) does a provider have to return an overpayment of $25 or more without
accruing interest? - ANSWER: 60 days
A billing and coding specialist is conducting an internal audit to analyze reimbursement
for a provider practice. Which of the following should the specialist understand is the
basis for reimbursement? - ANSWER: Diagnosis related group (DRG)
billing and coding specialist is preparing to submit a claim for a service that requires
preauthorization. Preauthorization must be requested by which of the following
individuals? - ANSWER: Treating provider
Which of the following can be performed when billing procedural codes? - ANSWER:
Billing using two-digit CPT modifiers to indicate a procedure performed differs from the
usual five-digit code
which of the following is a key protection standard of the HIPAA privacy rule that
requires entities and business associates to limit the use or release of protected health
information phi)? - ANSWER: minimum necessary
A billing and coding specialist is preparing a claim that includes code A9698. Which of
the following actions should the specialist take to ensure the claim will be paid the first
time it is submitted? - ANSWER: append the appropriate physical status modifier to the
code
Which of the following describes the status of a claim that is in process and does not
include required preauthorization for a service? - ANSWER: suspended
A third-party payer requests a patients information related to a claim. A billing and
coding specialist should ensure that which of the following is included in the patients file
before providing the information? - ANSWER: signed release of information form
A lightning bolt symbol that precedes a code indicates which of the following? -
ANSWER: code indicates a service is pending FDA approval
A billing and coding specialist is using an accounts receivable aging report to determine
which accounts should be sent to collection. According to best practice, which of the
following accounts should the specialist send to collections? - ANSWER: An account
that has a balance of $600 and 135 days old.
Which of the following CPT codes should a billing and coding specialist use to indicate a
total prostate specific antigen (PSA) test? - ANSWER: 84153
Which of the following is the purpose of a claims clearinghouse? - ANSWER: To identify
errors that will prevent a claim from being paid
Which of the following describes a claim that is 120 days old? - ANSWER: delinquent
Which of the following plans requires providers to adhere to managed care provisions? -
ANSWER: health maintenance organization (HMO) plan
According to the ICD-10-CM coding guidelines, the fourth character of an ICD-10-CM
diagnosis code indicates which of the following? - ANSWER: anatomic site
Which of the following codes are used to code diseases, injuries, impairments, and
other health-related problems? - ANSWER: ICD-10-CM codes
, An internal retrospective billing account audit prevents fraud and abuse by reviewing
and comparing completed claim forms with which of the following? - ANSWER:
Documentation of compliance plans
which of the following types of insurance do health care professionals purchase to
protect themselves from liability relating to claims arising from patient treatments? -
ANSWER: medical malpractice
A new patient is seen in the office for frequent urination and excessive thirst. The
provider performs a detailed history and examination. Which of the following coding
manual should a billing and coding specialist reference to determine the Evaluation and
Management (E/M) level of care for the visit? - ANSWER: CPT
A billing and coding specialist should consider which of the following when determining
an evaluation and management (E/M) code. - ANSWER: place of service
A billing and coding specialist is a preparing a claim for a patient who had an Evaluation
and Management (E/M) visit for abdominal pain that resulted in the decision to remove
the appendix immediately. Which of the following modifier should use for this claim? -
ANSWER: 25 modifier
patient who has a past due balance requests their records be sent to another provider.
Which of the following actions should the billing and coding specialist take with regards
to the records request? - ANSWER: Begin collection action on the balance due.
After a third-party payer validates a claim, which of the following takes place next? -
ANSWER: Claim adjudication
How many days after receipt of an initial demand letter from a Medicare administrative
contractor (MAC) does a provider have to return an overpayment of $25 or more without
accruing interest? - ANSWER: 60 days
A billing and coding specialist is conducting an internal audit to analyze reimbursement
for a provider practice. Which of the following should the specialist understand is the
basis for reimbursement? - ANSWER: Diagnosis related group (DRG)
billing and coding specialist is preparing to submit a claim for a service that requires
preauthorization. Preauthorization must be requested by which of the following
individuals? - ANSWER: Treating provider
Which of the following can be performed when billing procedural codes? - ANSWER:
Billing using two-digit CPT modifiers to indicate a procedure performed differs from the
usual five-digit code
