NHA CBCS CERTIFICATION EXAM 2024 ACTUAL EXAM
COMPLETE 300 QUESTIONS WITH DETAILED VERIFIED
ANSWERS (100% CORRECT ANSWERS) /ALREADY GRADED A+
When does communication with the
patient begin?
A. Patient check-in
B. Registration and scheduling
C. Health care encounter
D. Patient Check Out - ANSWER: B. Registration and scheduling.
Explanation: Communication starts at the
point of service, during registration and
scheduling, where the information is gathered
from the patient to create an account
What is a third-party payer? - ANSWER: Healthcare insurance company
that reimburses services
provided by providers and/
or health care organizations.
Terminology - ANSWER: As health care changes, so do the terms
we use. It is important to know and use
current health care terminology. For
example, the CMS-1500 (paper) form was
previously called the HCFA-1500 form.
What is a provider? - ANSWER: A provider is a licensed professional
who can submit claims to a third-
party payer. This individual can be a
physician, nurse practitioner, physical or
occupational therapist, hospital, or any
qualified professional who is licensed
to provide health care services
What are the Office of Inspector General responsible for? - ANSWER: The OIG is a
division of the Department of Health and Human Services (HHS) and is responsible
for investigating insurance fraud and abuse related to Medicare, Medicaid, and other
federally funded programs.
What is the intent of the Office of the
, Inspector General? - ANSWER: Identify and eliminate fraud, abuse, and waste
Covered entity. - ANSWER: Entity that transmits health information in electronic
form (e.g., providers, health plans, clearinghouses)
Electronic Data Interchange. - ANSWER: Computer technology that contains the
exchange of data between the health care provider and payer
Fraud - ANSWER: Intentionally billing for services not performed, reporting
fraudulent diagnosis, or medical coding errors.
Abuse - ANSWER: Billing patterns and practices that are excessive or unnecessary but
not fraudulent.
HIPAA - ANSWER: HIPAA not only protects protected health
information (PHI) in electronic or paper
records, but PHI is also protected in the
verbal form. A conversation with another staff
member can violate PHI depending on where
and how the conversation takes place.
Clinical Use - ANSWER: Information about type and quality of care
Transmission - ANSWER: Patient eligibility
Storage - ANSWER: Backup
Administrative Use - ANSWER: Quality improvement
How can a compliance program help an
organization? - ANSWER: By providing the guidance and structure needed to meet
the goals of compliance
What is the purpose of Self-Disclosure
Protocol? - ANSWER: Self-disclosure allows for a provider or organization to
voluntarily report any evidence of potential fraud. The voluntary disclosure allows
the provider or organization to work with the OIG to resolve the issues identified in a
fair manner.
Accounts Receivable - ANSWER: The amount owed to a provider for health care
services rendered.
TAKE NOTE - ANSWER: When patient data is entered
incorrectly, there will be a delay
at the point of claim processing.
The insurance plan cannot process
a claim for reimbursement if the
COMPLETE 300 QUESTIONS WITH DETAILED VERIFIED
ANSWERS (100% CORRECT ANSWERS) /ALREADY GRADED A+
When does communication with the
patient begin?
A. Patient check-in
B. Registration and scheduling
C. Health care encounter
D. Patient Check Out - ANSWER: B. Registration and scheduling.
Explanation: Communication starts at the
point of service, during registration and
scheduling, where the information is gathered
from the patient to create an account
What is a third-party payer? - ANSWER: Healthcare insurance company
that reimburses services
provided by providers and/
or health care organizations.
Terminology - ANSWER: As health care changes, so do the terms
we use. It is important to know and use
current health care terminology. For
example, the CMS-1500 (paper) form was
previously called the HCFA-1500 form.
What is a provider? - ANSWER: A provider is a licensed professional
who can submit claims to a third-
party payer. This individual can be a
physician, nurse practitioner, physical or
occupational therapist, hospital, or any
qualified professional who is licensed
to provide health care services
What are the Office of Inspector General responsible for? - ANSWER: The OIG is a
division of the Department of Health and Human Services (HHS) and is responsible
for investigating insurance fraud and abuse related to Medicare, Medicaid, and other
federally funded programs.
What is the intent of the Office of the
, Inspector General? - ANSWER: Identify and eliminate fraud, abuse, and waste
Covered entity. - ANSWER: Entity that transmits health information in electronic
form (e.g., providers, health plans, clearinghouses)
Electronic Data Interchange. - ANSWER: Computer technology that contains the
exchange of data between the health care provider and payer
Fraud - ANSWER: Intentionally billing for services not performed, reporting
fraudulent diagnosis, or medical coding errors.
Abuse - ANSWER: Billing patterns and practices that are excessive or unnecessary but
not fraudulent.
HIPAA - ANSWER: HIPAA not only protects protected health
information (PHI) in electronic or paper
records, but PHI is also protected in the
verbal form. A conversation with another staff
member can violate PHI depending on where
and how the conversation takes place.
Clinical Use - ANSWER: Information about type and quality of care
Transmission - ANSWER: Patient eligibility
Storage - ANSWER: Backup
Administrative Use - ANSWER: Quality improvement
How can a compliance program help an
organization? - ANSWER: By providing the guidance and structure needed to meet
the goals of compliance
What is the purpose of Self-Disclosure
Protocol? - ANSWER: Self-disclosure allows for a provider or organization to
voluntarily report any evidence of potential fraud. The voluntary disclosure allows
the provider or organization to work with the OIG to resolve the issues identified in a
fair manner.
Accounts Receivable - ANSWER: The amount owed to a provider for health care
services rendered.
TAKE NOTE - ANSWER: When patient data is entered
incorrectly, there will be a delay
at the point of claim processing.
The insurance plan cannot process
a claim for reimbursement if the
