2024 NHA CBCS Practice Exam Questions & Correct
Answers
Medical Ethics are - ANSWER-Standards of conduct based on moral principals.
Acting within ethical behavior boundaries means carrying out one's responsibilities
with integrity, decency, respect, honesty, competence, fairness, and trust.
Compliance Regulations - ANSWER-Most billing related cases are based on
HIPAA and the False Claims Act
HIPAA is an acronym for - ANSWER-Heath Insurance Portability and
Accountability Act of 1996
Category 1 CPT codes - ANSWER-Medical Procedures
Category 2 CPT codes - ANSWER-Supplemental Codes for Performance
Measures
Category 3 CPT codes - ANSWER-Emerging Technologies
Add on Codes - ANSWER-Used for procedures that always performed during the
same operative session, as another surgery in addition to the primary
service/procedure and is never performed separately
Anesthesia is found - ANSWER-00100-01999 and 99100-99140
,Evaluation and Management (E&M) codes - ANSWER-Are listed first in the CPT
manual because they are used by all the different specialties
Brackets - ANSWER-Used to enclose synonyms, alternative wording or and
explanatory phrase
Bullets - ANSWER-Represents a new procedure or services code added since the
previous edition of the manual
Chief Complaint (CC) - ANSWER-The reason the patient came to see the
physician
What do the group codes CO, CR, OA, PR - ANSWER-CO - CONTRACTUAL
OBLIGATION
CR - CORRECTION AND RENEWAL
OA - OTHER ADJUSTMENT
PR - PATIENT RESPONSIBILITY
The department of ________________________________ refers patients to a
specialty department for further treatment - ANSWER-Internal/Family Medicine
Define prefix Hypo- - ANSWER-Below, deficient
What is a precertification? - ANSWER-A review that looks at whether the
procedure could be performed safely but less expensively in an outpatient setting.
What are Category I CPT Codes? - ANSWER-Physician services and hospital
outpatient coding
,Aging Reports are maintained in ________ increments - ANSWER-30 day
Explain the parts of Medicare A, B, C, and D - ANSWER-A -
Hospitalization/Inpatient
B - Outpatient/Physician/Professional Services
C - Medicare Advantage Plans
D - Drug Coverage
What does Block 13 on the CMS 1500 claim form indicate? - ANSWER-The
signature of the patient authorizing the payment of benefits to the provider/supplier
What does Coordination of Benefits mean? - ANSWER-Determines which
insurance plan is primary and which is secondary
What does the Fair Debt Collection Practices Act say debt collectors can't do? -
ANSWER-Use unfair or abusive practices to collect a debt
What is a deductible? - ANSWER-a specified amount of money that the insured
must pay before an insurance company will pay a claim
What is the difference between Medial and Lateral? - ANSWER-Medial - Middle
of the body
Lateral - To the side
What is PHI? - ANSWER-Protected Health Information
What is the location method in reference to the CPT book? - ANSWER-Procedure
or service
, Just anatomic site
Condition or disease
Synonym, eponym, or abbreviation
What is the Stark Law? - ANSWER-Prohibits a physician from referring patients
for certain designated health services (Medicare & Medicaid) to entities with
whom the physician has a financial relationship
What is the timely filing limitation for Medicare? - ANSWER-1 year
What does Block 12 on the CMS-1500 form indicate? - ANSWER-Patient's
signature authorizing the release of medical information to the insurance company
in order to process the claim.
What is the birthday rule? - ANSWER-The insurance policy of the
policyholder(parent) whose birthday comes first in the calendar year is the primary
payer for all dependents.
What is the difference between a Remittance Advice and Explanation of Benefits?
- ANSWER-A Remittance Advice is the breakdown of payments and denials sent
from the 3rd party payer to the provider.
Explanation of Benefits is the same but sent to the patient
What is the difference between HMOs and PPOs? - ANSWER-HMOs offer NO
out of network benefits and requires referrals to specialists.
PPOs have more flexibility, out of network benefits, and do not require referrals to
specialists.
Answers
Medical Ethics are - ANSWER-Standards of conduct based on moral principals.
Acting within ethical behavior boundaries means carrying out one's responsibilities
with integrity, decency, respect, honesty, competence, fairness, and trust.
Compliance Regulations - ANSWER-Most billing related cases are based on
HIPAA and the False Claims Act
HIPAA is an acronym for - ANSWER-Heath Insurance Portability and
Accountability Act of 1996
Category 1 CPT codes - ANSWER-Medical Procedures
Category 2 CPT codes - ANSWER-Supplemental Codes for Performance
Measures
Category 3 CPT codes - ANSWER-Emerging Technologies
Add on Codes - ANSWER-Used for procedures that always performed during the
same operative session, as another surgery in addition to the primary
service/procedure and is never performed separately
Anesthesia is found - ANSWER-00100-01999 and 99100-99140
,Evaluation and Management (E&M) codes - ANSWER-Are listed first in the CPT
manual because they are used by all the different specialties
Brackets - ANSWER-Used to enclose synonyms, alternative wording or and
explanatory phrase
Bullets - ANSWER-Represents a new procedure or services code added since the
previous edition of the manual
Chief Complaint (CC) - ANSWER-The reason the patient came to see the
physician
What do the group codes CO, CR, OA, PR - ANSWER-CO - CONTRACTUAL
OBLIGATION
CR - CORRECTION AND RENEWAL
OA - OTHER ADJUSTMENT
PR - PATIENT RESPONSIBILITY
The department of ________________________________ refers patients to a
specialty department for further treatment - ANSWER-Internal/Family Medicine
Define prefix Hypo- - ANSWER-Below, deficient
What is a precertification? - ANSWER-A review that looks at whether the
procedure could be performed safely but less expensively in an outpatient setting.
What are Category I CPT Codes? - ANSWER-Physician services and hospital
outpatient coding
,Aging Reports are maintained in ________ increments - ANSWER-30 day
Explain the parts of Medicare A, B, C, and D - ANSWER-A -
Hospitalization/Inpatient
B - Outpatient/Physician/Professional Services
C - Medicare Advantage Plans
D - Drug Coverage
What does Block 13 on the CMS 1500 claim form indicate? - ANSWER-The
signature of the patient authorizing the payment of benefits to the provider/supplier
What does Coordination of Benefits mean? - ANSWER-Determines which
insurance plan is primary and which is secondary
What does the Fair Debt Collection Practices Act say debt collectors can't do? -
ANSWER-Use unfair or abusive practices to collect a debt
What is a deductible? - ANSWER-a specified amount of money that the insured
must pay before an insurance company will pay a claim
What is the difference between Medial and Lateral? - ANSWER-Medial - Middle
of the body
Lateral - To the side
What is PHI? - ANSWER-Protected Health Information
What is the location method in reference to the CPT book? - ANSWER-Procedure
or service
, Just anatomic site
Condition or disease
Synonym, eponym, or abbreviation
What is the Stark Law? - ANSWER-Prohibits a physician from referring patients
for certain designated health services (Medicare & Medicaid) to entities with
whom the physician has a financial relationship
What is the timely filing limitation for Medicare? - ANSWER-1 year
What does Block 12 on the CMS-1500 form indicate? - ANSWER-Patient's
signature authorizing the release of medical information to the insurance company
in order to process the claim.
What is the birthday rule? - ANSWER-The insurance policy of the
policyholder(parent) whose birthday comes first in the calendar year is the primary
payer for all dependents.
What is the difference between a Remittance Advice and Explanation of Benefits?
- ANSWER-A Remittance Advice is the breakdown of payments and denials sent
from the 3rd party payer to the provider.
Explanation of Benefits is the same but sent to the patient
What is the difference between HMOs and PPOs? - ANSWER-HMOs offer NO
out of network benefits and requires referrals to specialists.
PPOs have more flexibility, out of network benefits, and do not require referrals to
specialists.
