NHA CBCS EXAM ACTUAL EXAM 200 QUESTIONS AND
CORRECT ANSWERS (DETAILED AND VERIFIED
ANSWERS) |ALREADY GRADED A+
What actions should be taken when a claim is billed for a level four office visit and
paid at a level three? - ANSWER: Submit an appeal with documentation
The standard medical abbreviation "ECG" refers to a test used to assess which of the
body systems? - ANSWER: cardiovascular system- test checks electricity of heart
According to HIPAA standards, what identifies the rendering provider on the CMS-
1500 claim form in Block 24J? - ANSWER: NPI
On the CMS-1500 claim form, blocks 14 through 33 contain information about? -
ANSWER: The patient's condition and the provider's information
Which block should the BCS complete on the CMS-1500 form for procedures,
services, or supplies? - ANSWER: 24D
Which term describes when a plan pays 70% of the allowed and the patient pays
30%? - ANSWER: Coinsurance is a percentage of the cost for covered services that is
approved by the insurance company
A provider charges $500 to a claim that had an allowable amount of $400. What
should happen to the non-allowed charge? - ANSWER: Write Off or adjustment
Patient: Justin Austin; Social Security NO.: 555-22-1111; Medicare ID NO.: 555-33-
2222A; DOB: 05/22/1945. Claim information entered: Austin, Jane; Social Security
No.: 555-22-111; Medicare ID No.: 555-33-2222A; DOB: 052245. What is a reason
the claim was rejected? - ANSWER: The DOB is entered incorrectly - the format is
two digits for the month and four digits for the year.
A patient's health plan is referred to as the "payer of last resort." The patient is
covered by which health plan? - ANSWER: Medicaid
The physician bills $500 to a patient. After submitting the claim to the insurance
company, the claim is sent back with no payment. The patient still owes $500 for the
year. This amount is called what? - ANSWER: Deductible
Ambulatory surgery centers, home health care, and hospice organizations use what
form? - ANSWER: UB-04 Form
A physician ordered a comprehensive metabolic panel for a 70-year-old patient who
has Medicare as her primary insurance. Which form is required so the patient knows
she may be responsible for payment? - ANSWER: Advanced Beneficiary Notice is a
form that is required for Medicare recipients
, Which of the following should the BCS complete to be reimbursed for the provider's
services? - ANSWER: CMS-1500 claim form
What is the maximum number of diagnoses that can be reported on the CMS-1500
claim form before a further claim is required? - ANSWER: 12
Describe a delinquent claim? - ANSWER: It is considered delinquent when it is
overdue for payment, 120 days or older
What are considered proper supportive documentation for reporting CPT and ICD
codes for surgical procedures? - ANSWER: Operative reports are required to support
surgical procedures
When submitting a clean claim with a diagnosis of kidney stones, which of the
following procedure names is correct? - ANSWER: Nephrolithiasis The destruction of
kidney stones
The BCS should first divide the e/m code by which of the following? - ANSWER: Place
of service which narrows down the specific code as one of the three deciding factors
Appeal the decision with a provider's report - ANSWER: Which of the following
actions should be taken if an insurance company denies a service as not medically
necessary?
Which departments should a patient be seen for psoriasis? And what body system is
involved? - ANSWER: Dermatology, related to the integumentary system which
includes hair, skin, and nails
Which block requires the patient's authorization to release medical information to
process a claim? - ANSWER: Block 12
What is the purpose of precertification? - ANSWER: Verification of Coverage
A provider performs an examination of a patient's sore throat during an office visit.
What describes the level of the examination? - ANSWER: Problem-focused
examination is a specific examination of an affected organ.
What is the verbal or written agreement that gives approval to some action,
situation, or statement, and allows the release of patient information? - ANSWER:
Consent agreement
On the CMS-1500 claim form, blocks 1 through 13 include what information? -
ANSWER: The patient's demographics are found in Blocks 2,3,5, and 7
What is the main function of the respiratory system? - ANSWER: Oxygenating blood
cells
CORRECT ANSWERS (DETAILED AND VERIFIED
ANSWERS) |ALREADY GRADED A+
What actions should be taken when a claim is billed for a level four office visit and
paid at a level three? - ANSWER: Submit an appeal with documentation
The standard medical abbreviation "ECG" refers to a test used to assess which of the
body systems? - ANSWER: cardiovascular system- test checks electricity of heart
According to HIPAA standards, what identifies the rendering provider on the CMS-
1500 claim form in Block 24J? - ANSWER: NPI
On the CMS-1500 claim form, blocks 14 through 33 contain information about? -
ANSWER: The patient's condition and the provider's information
Which block should the BCS complete on the CMS-1500 form for procedures,
services, or supplies? - ANSWER: 24D
Which term describes when a plan pays 70% of the allowed and the patient pays
30%? - ANSWER: Coinsurance is a percentage of the cost for covered services that is
approved by the insurance company
A provider charges $500 to a claim that had an allowable amount of $400. What
should happen to the non-allowed charge? - ANSWER: Write Off or adjustment
Patient: Justin Austin; Social Security NO.: 555-22-1111; Medicare ID NO.: 555-33-
2222A; DOB: 05/22/1945. Claim information entered: Austin, Jane; Social Security
No.: 555-22-111; Medicare ID No.: 555-33-2222A; DOB: 052245. What is a reason
the claim was rejected? - ANSWER: The DOB is entered incorrectly - the format is
two digits for the month and four digits for the year.
A patient's health plan is referred to as the "payer of last resort." The patient is
covered by which health plan? - ANSWER: Medicaid
The physician bills $500 to a patient. After submitting the claim to the insurance
company, the claim is sent back with no payment. The patient still owes $500 for the
year. This amount is called what? - ANSWER: Deductible
Ambulatory surgery centers, home health care, and hospice organizations use what
form? - ANSWER: UB-04 Form
A physician ordered a comprehensive metabolic panel for a 70-year-old patient who
has Medicare as her primary insurance. Which form is required so the patient knows
she may be responsible for payment? - ANSWER: Advanced Beneficiary Notice is a
form that is required for Medicare recipients
, Which of the following should the BCS complete to be reimbursed for the provider's
services? - ANSWER: CMS-1500 claim form
What is the maximum number of diagnoses that can be reported on the CMS-1500
claim form before a further claim is required? - ANSWER: 12
Describe a delinquent claim? - ANSWER: It is considered delinquent when it is
overdue for payment, 120 days or older
What are considered proper supportive documentation for reporting CPT and ICD
codes for surgical procedures? - ANSWER: Operative reports are required to support
surgical procedures
When submitting a clean claim with a diagnosis of kidney stones, which of the
following procedure names is correct? - ANSWER: Nephrolithiasis The destruction of
kidney stones
The BCS should first divide the e/m code by which of the following? - ANSWER: Place
of service which narrows down the specific code as one of the three deciding factors
Appeal the decision with a provider's report - ANSWER: Which of the following
actions should be taken if an insurance company denies a service as not medically
necessary?
Which departments should a patient be seen for psoriasis? And what body system is
involved? - ANSWER: Dermatology, related to the integumentary system which
includes hair, skin, and nails
Which block requires the patient's authorization to release medical information to
process a claim? - ANSWER: Block 12
What is the purpose of precertification? - ANSWER: Verification of Coverage
A provider performs an examination of a patient's sore throat during an office visit.
What describes the level of the examination? - ANSWER: Problem-focused
examination is a specific examination of an affected organ.
What is the verbal or written agreement that gives approval to some action,
situation, or statement, and allows the release of patient information? - ANSWER:
Consent agreement
On the CMS-1500 claim form, blocks 1 through 13 include what information? -
ANSWER: The patient's demographics are found in Blocks 2,3,5, and 7
What is the main function of the respiratory system? - ANSWER: Oxygenating blood
cells
