NHA BILLING AND CODING EXAM 2023 TEST BANK 200
QUESTIONS AND CORRECT ANSWERS(CBCS)
What Medicare policy determines if a particular item or service is covered by
Medicare? - ANSWER: National Coverage Determination (NCD)
NCD stands for - - ANSWER: National Coverage Determinations
PPS stands for - - ANSWER: Prospective Payment System
ABN stands for - - ANSWER: Advance Beneficiary Notice
RBRVS stands for - ANSWER: Resource Based Relative Value Scale
What is National Coverage Determination? - ANSWER: Medicare policy stating
whether and under what circumstances a service is covered by the Medicare
program
What is Prospective Payment System? - ANSWER: Method of reimbursement in
which the Medicare payment for patient services is made based on a predetermined
fixed amount
What is Advanced Beneficiary Notice? - ANSWER: A form Medicare patients will sign
when the provider thinks Medicare might not pay for a specific service or item and
that patient may be responsible for charges
What is Resource-Based Relative Value Scale? - ANSWER: Used for establishing
Medicare fees
A patients employer has not submitted a premium payment. What claim status
should the provider receive from the third party payer? - ANSWER: Denied
What report should you analyze routinely to determine the number of outstanding
claims? - ANSWER: Aging Report
What is Accounts Payable Report? - ANSWER: Report on how much money the
practice owes
What is an aging report? - ANSWER: Tracks outstanding balances by the length of
time the charges have been due
What is Remittance Advice? - ANSWER: a document supplied by the insurance payer
that provides notice and explanation of reasons for payment, adjustment, denial
and/or uncovered charges of a medical claim.
, What is Explanation of Benefits? - ANSWER: An explanation of benefits is provided to
the patient by the insurance company as a statement detailing what services are
paid, denied, or reduced in payment
Informed Consent - ANSWER: Provider 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 - ANSWER: A patient presents for treatment, such as extending an
arm to allow a venipuncture to be performed.
Difference between Informed and Implied consent? - ANSWER: Informed consent is
required in writing after explanation of a procedure, with time to ask questions,
while implied consent is assumed.
Clearinghouse - ANSWER: Agency that converts claims into a standardized electronic
format, looks for errors, and formats them according to HIPAA and insurance
standards.
Individually Identifiable - ANSWER: Documents that identify the person or provide
enough information so that the person could be identified.
De-Identified Information - ANSWER: Information that does not identify an individual
because unique and personal characteristics have been removed.
Consent - ANSWER: A patient's permission evidenced by signature.
Authorization - ANSWER: Permission granted by the patient or the patient's
representative to release information for reasons other than treatment, payment, or
health care operations.
Reimbursement - ANSWER: Payment for services rendered from a third-party payer.
Auditing - ANSWER: Review of claims for accuracy and completeness.
Fraud - ANSWER: Making false statements of representations of material facts to
obtain some benefit or payment for which no entitlement would otherwise exist.
Upcoding - ANSWER: Assigning a diagnosis or procedure code at a higher level than
the documentation supports, such as coding bronchitis as pneumonia.
Unbundling - ANSWER: Using multiple codes that describe different components of a
treatment instead of using a single code that describes all steps of the procedure.
Abuse - ANSWER: Practices that directly or indirectly result in unnecessary costs to
the Medicare program.
QUESTIONS AND CORRECT ANSWERS(CBCS)
What Medicare policy determines if a particular item or service is covered by
Medicare? - ANSWER: National Coverage Determination (NCD)
NCD stands for - - ANSWER: National Coverage Determinations
PPS stands for - - ANSWER: Prospective Payment System
ABN stands for - - ANSWER: Advance Beneficiary Notice
RBRVS stands for - ANSWER: Resource Based Relative Value Scale
What is National Coverage Determination? - ANSWER: Medicare policy stating
whether and under what circumstances a service is covered by the Medicare
program
What is Prospective Payment System? - ANSWER: Method of reimbursement in
which the Medicare payment for patient services is made based on a predetermined
fixed amount
What is Advanced Beneficiary Notice? - ANSWER: A form Medicare patients will sign
when the provider thinks Medicare might not pay for a specific service or item and
that patient may be responsible for charges
What is Resource-Based Relative Value Scale? - ANSWER: Used for establishing
Medicare fees
A patients employer has not submitted a premium payment. What claim status
should the provider receive from the third party payer? - ANSWER: Denied
What report should you analyze routinely to determine the number of outstanding
claims? - ANSWER: Aging Report
What is Accounts Payable Report? - ANSWER: Report on how much money the
practice owes
What is an aging report? - ANSWER: Tracks outstanding balances by the length of
time the charges have been due
What is Remittance Advice? - ANSWER: a document supplied by the insurance payer
that provides notice and explanation of reasons for payment, adjustment, denial
and/or uncovered charges of a medical claim.
, What is Explanation of Benefits? - ANSWER: An explanation of benefits is provided to
the patient by the insurance company as a statement detailing what services are
paid, denied, or reduced in payment
Informed Consent - ANSWER: Provider 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 - ANSWER: A patient presents for treatment, such as extending an
arm to allow a venipuncture to be performed.
Difference between Informed and Implied consent? - ANSWER: Informed consent is
required in writing after explanation of a procedure, with time to ask questions,
while implied consent is assumed.
Clearinghouse - ANSWER: Agency that converts claims into a standardized electronic
format, looks for errors, and formats them according to HIPAA and insurance
standards.
Individually Identifiable - ANSWER: Documents that identify the person or provide
enough information so that the person could be identified.
De-Identified Information - ANSWER: Information that does not identify an individual
because unique and personal characteristics have been removed.
Consent - ANSWER: A patient's permission evidenced by signature.
Authorization - ANSWER: Permission granted by the patient or the patient's
representative to release information for reasons other than treatment, payment, or
health care operations.
Reimbursement - ANSWER: Payment for services rendered from a third-party payer.
Auditing - ANSWER: Review of claims for accuracy and completeness.
Fraud - ANSWER: Making false statements of representations of material facts to
obtain some benefit or payment for which no entitlement would otherwise exist.
Upcoding - ANSWER: Assigning a diagnosis or procedure code at a higher level than
the documentation supports, such as coding bronchitis as pneumonia.
Unbundling - ANSWER: Using multiple codes that describe different components of a
treatment instead of using a single code that describes all steps of the procedure.
Abuse - ANSWER: Practices that directly or indirectly result in unnecessary costs to
the Medicare program.
