NHA CBCS Exam Practice 1
___________ is the national health insurance program for Americans aged 65 and older. -
ANS-Medicare
\"A concurrent condition that coexists with the first-listed diagnosis or principal diagnosis, has
potential to affect treatment of the aforementioned diagnosis and is an active condition for
which the patient is treated and/or monitored." - ANS-Comorbidity
\"A condition that develops after the outpatient care has been provided or during an inpatient
admission." - ANS-Complication
\"A severe form of hypertension with vascular damage and a diastolic pressure reading of
130 mm hg or greater." - ANS-Malignant
\"Mild and/or controlled hypertension, with no damage to the patient's vascular system or
organs." - ANS-Benign
\"No notation of benign or malignant status is found in the diagnosis or in the patient's chart."
- ANS-Unspecified
\"The difference between fraud and abuse is _______." - ANS-Intent
\4 contributing factors for E&M Codes - ANS-New or existing patient, History, Physical Exam,
Medical Decision making, Time spent can be a 5th factor
\A detailed accounting of the claims for which payment is being made by an insurance
company. The __________ accompanies the payment from the insurance company. -
ANS-Remittance Advice (RA)
\A fixed fee collected at the time of the patients visit. - ANS-Copayment
\A fixed percentage of covered charges applied to the patients bill after the deductible has
been met. - ANS-Coinsurance
\A formal, written document that describes how the hospital or physician's practice ensures
rules, regulations, and standards that are being followed is known as a/an
_______________. - ANS-Compliance Plan
\A group that takes nonstandard medical billing software formats and translates them into
the standard Electronic Data Interchange (EDI) formats is called a/an? - ANS-Clearinghouse
\A health-benefit program designed for low-income, blind, or disabled patients; needy
families; foster children; and children born with birth defects. - ANS-Medicaid "payer of last
resort"
\A managed care organization that establishes a network of providers who care for their
patients is called a/an _________. - ANS-Preferred Provider Organization (PPO)
\A person filing an appeal is called? - ANS-Claimant
\A person who receives a check in payment is the _________. - ANS-Payee
\A writ requiring the appearance of a person at a trial or other proceeding is a ___________.
- ANS-subpoena
\A/An ___________ is a person admitted to a hospital or long-term care facility(LTCF) for
treatment with the expectation that the patient will remain in the hospital for a period of 24
hours or more. - ANS-Inpatient
\ABN / Advance Beneficiary Notice - ANS-a notice that a doctor, supplier, or provider gives a
Medicare beneficiary before furnishing an item or service if the doctor, supplier, or provider
believes that Medicare may deny payment.
, \Add on Codes - ANS-Used for procedures that are 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 - ANS-00100-01999, 99100-99140
\Authorization by a policyholder that allows a payer to pay benefits directly to a provider is
called? - ANS-Assignment of Benefits
\Basic Billing Reimbursement Steps - ANS-Patient Info, Verify Ins. Prepare encounter form,
Code DX & CPT, Review Linkage Protocol, Calculate physicians charges, Prepare claim,
Transmit claim, Follow up on Reimbursement.
\Billing a patient for the difference between a higher usual fee and a lower allowed charge is
called _____________. - ANS-Balance Billing
\Brackets - ANS-Used to enclose synonyms, alternative wording or and explanatory phrase
\Bullet means - ANS-new procedure code
\Bullets - ANS-Represents a new procedure or service code added since the previous
edition of the manual.
\Category 1 CPT codes - ANS-Medical Procedures
\Category 2 CPT codes - ANS-Supplemental Codes for Performance Measures
\Category 3 CPT codes - ANS-Emerging Technologies
\CHAMPVA - ANS-comprehensive health care program in which the VA shares the cost of
covered health care services and supplies with eligible beneficiaries.
\Chief Complaint (CC) - ANS-The reason the patient came to see the physician.
\Circle with a line through it - ANS-exemption from modifier 51
\Circle with a line through it means - ANS-modifier 51 exempt code
\Clean Claim - ANS-A completed insurance claim form submitted with the program time limit
that contains all the necessary information without deficiencies so it can be processed and
paid promptly.
\CMS 1500 Universal Claim Form - ANS-Developed by the AMA and the Centers for
Medicare and Medicaid Services (CMS). Used by physicians and other professionals to bill
outpatient services and supplies to Tricare, Medicare, some Medicaid programs, and some
private insurance/managed care plans
\Coding and billing that is inconsistent with typical coding and billing practices. - ANS-Abuse
\Compliance Regulations - ANS-Most billing related cases are based on HIPAA and the
False Claims Act
\Covers injuries caused by insured that occurred on the insured's property. - ANS-Liability
Insurance
\CPT - ANS-Used to report services and procedures by physicians
\Current Procedural Terminology (CPT) codes - ANS-Numeric codes developed by the
American Medical Association (AMA) to standardize medical services and procedures.
\Dirty Claim - ANS-A claim submitted with errors or one that requires manual processing to
resolve problems or is rejected for payment.
\Disability Insurance - ANS-Insurance policy that pays benefits in the event that the
policyholder becomes incapable of working.
\E Codes - ANS-For durable medical equipment for use in home
\E&M Codes - ANS-99201-99499
\Electronic Claim - ANS-An insurance claim submitted to the insurance carrier via a central
processing unit (CPU), tape, diskette, direct data entry, direct wire, dial-in telephone, digital
fax, or personal computer download or upload
___________ is the national health insurance program for Americans aged 65 and older. -
ANS-Medicare
\"A concurrent condition that coexists with the first-listed diagnosis or principal diagnosis, has
potential to affect treatment of the aforementioned diagnosis and is an active condition for
which the patient is treated and/or monitored." - ANS-Comorbidity
\"A condition that develops after the outpatient care has been provided or during an inpatient
admission." - ANS-Complication
\"A severe form of hypertension with vascular damage and a diastolic pressure reading of
130 mm hg or greater." - ANS-Malignant
\"Mild and/or controlled hypertension, with no damage to the patient's vascular system or
organs." - ANS-Benign
\"No notation of benign or malignant status is found in the diagnosis or in the patient's chart."
- ANS-Unspecified
\"The difference between fraud and abuse is _______." - ANS-Intent
\4 contributing factors for E&M Codes - ANS-New or existing patient, History, Physical Exam,
Medical Decision making, Time spent can be a 5th factor
\A detailed accounting of the claims for which payment is being made by an insurance
company. The __________ accompanies the payment from the insurance company. -
ANS-Remittance Advice (RA)
\A fixed fee collected at the time of the patients visit. - ANS-Copayment
\A fixed percentage of covered charges applied to the patients bill after the deductible has
been met. - ANS-Coinsurance
\A formal, written document that describes how the hospital or physician's practice ensures
rules, regulations, and standards that are being followed is known as a/an
_______________. - ANS-Compliance Plan
\A group that takes nonstandard medical billing software formats and translates them into
the standard Electronic Data Interchange (EDI) formats is called a/an? - ANS-Clearinghouse
\A health-benefit program designed for low-income, blind, or disabled patients; needy
families; foster children; and children born with birth defects. - ANS-Medicaid "payer of last
resort"
\A managed care organization that establishes a network of providers who care for their
patients is called a/an _________. - ANS-Preferred Provider Organization (PPO)
\A person filing an appeal is called? - ANS-Claimant
\A person who receives a check in payment is the _________. - ANS-Payee
\A writ requiring the appearance of a person at a trial or other proceeding is a ___________.
- ANS-subpoena
\A/An ___________ is a person admitted to a hospital or long-term care facility(LTCF) for
treatment with the expectation that the patient will remain in the hospital for a period of 24
hours or more. - ANS-Inpatient
\ABN / Advance Beneficiary Notice - ANS-a notice that a doctor, supplier, or provider gives a
Medicare beneficiary before furnishing an item or service if the doctor, supplier, or provider
believes that Medicare may deny payment.
, \Add on Codes - ANS-Used for procedures that are 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 - ANS-00100-01999, 99100-99140
\Authorization by a policyholder that allows a payer to pay benefits directly to a provider is
called? - ANS-Assignment of Benefits
\Basic Billing Reimbursement Steps - ANS-Patient Info, Verify Ins. Prepare encounter form,
Code DX & CPT, Review Linkage Protocol, Calculate physicians charges, Prepare claim,
Transmit claim, Follow up on Reimbursement.
\Billing a patient for the difference between a higher usual fee and a lower allowed charge is
called _____________. - ANS-Balance Billing
\Brackets - ANS-Used to enclose synonyms, alternative wording or and explanatory phrase
\Bullet means - ANS-new procedure code
\Bullets - ANS-Represents a new procedure or service code added since the previous
edition of the manual.
\Category 1 CPT codes - ANS-Medical Procedures
\Category 2 CPT codes - ANS-Supplemental Codes for Performance Measures
\Category 3 CPT codes - ANS-Emerging Technologies
\CHAMPVA - ANS-comprehensive health care program in which the VA shares the cost of
covered health care services and supplies with eligible beneficiaries.
\Chief Complaint (CC) - ANS-The reason the patient came to see the physician.
\Circle with a line through it - ANS-exemption from modifier 51
\Circle with a line through it means - ANS-modifier 51 exempt code
\Clean Claim - ANS-A completed insurance claim form submitted with the program time limit
that contains all the necessary information without deficiencies so it can be processed and
paid promptly.
\CMS 1500 Universal Claim Form - ANS-Developed by the AMA and the Centers for
Medicare and Medicaid Services (CMS). Used by physicians and other professionals to bill
outpatient services and supplies to Tricare, Medicare, some Medicaid programs, and some
private insurance/managed care plans
\Coding and billing that is inconsistent with typical coding and billing practices. - ANS-Abuse
\Compliance Regulations - ANS-Most billing related cases are based on HIPAA and the
False Claims Act
\Covers injuries caused by insured that occurred on the insured's property. - ANS-Liability
Insurance
\CPT - ANS-Used to report services and procedures by physicians
\Current Procedural Terminology (CPT) codes - ANS-Numeric codes developed by the
American Medical Association (AMA) to standardize medical services and procedures.
\Dirty Claim - ANS-A claim submitted with errors or one that requires manual processing to
resolve problems or is rejected for payment.
\Disability Insurance - ANS-Insurance policy that pays benefits in the event that the
policyholder becomes incapable of working.
\E Codes - ANS-For durable medical equipment for use in home
\E&M Codes - ANS-99201-99499
\Electronic Claim - ANS-An insurance claim submitted to the insurance carrier via a central
processing unit (CPU), tape, diskette, direct data entry, direct wire, dial-in telephone, digital
fax, or personal computer download or upload
