NHA 2024-2025 CBCS Practice
Questions (Set 2):
Which of the following is considered Protected Health Information (PHI) under the Health
Insurance Portability and Accountability Act (HIPPA)?
Patient's email address
Emily, a 45-year old patient, has recently been diagnosed with a chronic condition that
requires ongoing treatment. Her primary insurance is through her employer, but she also has
a secondary insurance through her spouse's employer. When submitting claims for Emily's
treatment, what is the correct order of billing to ensure proper coordination of benefits?
Submit the claim to the primary insurance first, then the secondary insurance
Dr. Smith performed a minor surgical procedure on John Doe at an outpatient surgery
center. Which place of service code should be used for this procedure?
24- procedures performed in an ambulatory surgery center ASC)
Sarah, a medical billing specialist, is reviewing the account of a patient named John Doe.
She notices that the insurance company has a lack of pre-authorization for a specific
procedure. What is the best course of action for Sarah to take to resolve this issue?
Obtain the necessary pre-authorization and then resubmit the claim
Dr. Smith is submitting a CMS-1500 claim form for patient named John Doe, who received
outpatient services covered by medicare. Which section of the CMS-1500 form should Dr.
Smith complete to indicate the type of insurance plan covering John Doe?
- Box 1a- insured's ID Number
- Box 11- Insured Policy Group or FECA number
- Box 1- Insurance Type
- Box 24- Service Line Information
Box 1- Insurance Type
Which of the following is a primary purpose of internal audits in the context of medical billing
and coding?
To identify the correct coding errors before claim submissions
Dr. Smith's office received a request from John Does insurance company for his medical
records to process a claim. According to HIPPA regulations, what is the most appropriate
action for Dr. Smith's office to take?
,Provide only the minimum necessary information required to process the claim
When coding for Obstetrics, which of the following codes is used to indicate a routine
prenatal visit with no complications?
- Z34.00: Routine prenatal for normal first pregnancy no complications
- O09.89: Supervision of high risk pregnancy
- Z33.1: Encounter for pregnancy test
- O10.11: Pre-existing hypertension complicating pregnancy
Z34.00: Routine prenatal for normal first pregnancy no complications
Sarah, a patient. has recently filled for bankruptcy. As a medical billing specialist, what is the
appropriate action to take regarding her outstanding medical bills?
Cease all collection activities and notify the bankruptcy court
When coding for telemedicine services, which modifier should be appended to indicate the
service was provided via Telehealth?
Modifier 95
When a patient has multiple insurance plans, which insurance plan is typically considered
the primary insurance?
The insurance plan provided by the patients employer
Sarah, a medical billing specialist, is verifying insurance eligibility for a patient named John
who has a commercial insurance plan. Which of the following is a requirement she must
fulfill to ensure that John's insurance eligibility is verified correctly?
Confirm the patient's policy number and group number
Which of the following is the most crucial step in ensuring all applicable charges are
captured for optimal reimbursement?
Reviewing patient encounter forms and progress notes
Sarah, a patient with a PPO insurance plan, needs to undergo a specialized surgery. Her
preferred surgeon is out-of-network. Which of the following steps should Sarah take to
understand her out-of-network coverage and potential costs?
Contact her insurance company to verify out-of-network benefits and obtain
pre-authorization
What is the first step in the insurance eligibility and benefits verification process?
Verifying a patient's insurance coverage
, Sarah visits her primary care physician for a routine check-up. Her insurance plan has 20%
coinsurance rate after meeting a $200 deductible. The total bill for the visit is $500 , and
Sarah has already met her deductible for the year.How much is Sarah responsible for paying
out-of-pocket for this visit?
- $100
- $200
- $300
- $400
$100
When coding for a total knee arthroplasty in an orthopedic speciality, which of the following
CPT codes is the most appropriate?
27447
What is the primary purpose of a deductible in a health insurance policy?
To ensure the patient shares in the cost of their healthcare services
Which of the following government insurance plans primarily covers individuals aged 65 and
older, as well as certain individuals with disabilities?
Medicare
Mr. Johnson, a 68-year old patient, is enrolled in Medicare. He needs a comprehensive
understanding of his coverage options. Which part of Medicare will cover his inpatient
hospital stay if he is admitted for a surgical procedure?
Medicare Part A
Dr. Smith performed a laparoscopic cholecystectomy on a 45-year old patient named John
Doe. The procedure was uncomplicated, and the patient was discharged the same day.
Which CPT code should be used to accurately represent the procedure?
47562: Uncomplicated laparoscopic cholecystectomy
Sarah, a medical billing and coding specialist, is verifying insurance eligibility for a new
patient, John Doe, who has recently switched to a new insurance provider. What is the most
crucial piece of documentation Sarah needs to ensure John's insurance coverage is valid
before proceeding with the billing process?
A copy of John's new insurance card
Dr. Smith is submitting a CMS-1500 claim form for his patient John Doe, who received
outpatient services. Which field should Dr. Smith use to indicate the diagnoses code for John
Doe's condition?
Questions (Set 2):
Which of the following is considered Protected Health Information (PHI) under the Health
Insurance Portability and Accountability Act (HIPPA)?
Patient's email address
Emily, a 45-year old patient, has recently been diagnosed with a chronic condition that
requires ongoing treatment. Her primary insurance is through her employer, but she also has
a secondary insurance through her spouse's employer. When submitting claims for Emily's
treatment, what is the correct order of billing to ensure proper coordination of benefits?
Submit the claim to the primary insurance first, then the secondary insurance
Dr. Smith performed a minor surgical procedure on John Doe at an outpatient surgery
center. Which place of service code should be used for this procedure?
24- procedures performed in an ambulatory surgery center ASC)
Sarah, a medical billing specialist, is reviewing the account of a patient named John Doe.
She notices that the insurance company has a lack of pre-authorization for a specific
procedure. What is the best course of action for Sarah to take to resolve this issue?
Obtain the necessary pre-authorization and then resubmit the claim
Dr. Smith is submitting a CMS-1500 claim form for patient named John Doe, who received
outpatient services covered by medicare. Which section of the CMS-1500 form should Dr.
Smith complete to indicate the type of insurance plan covering John Doe?
- Box 1a- insured's ID Number
- Box 11- Insured Policy Group or FECA number
- Box 1- Insurance Type
- Box 24- Service Line Information
Box 1- Insurance Type
Which of the following is a primary purpose of internal audits in the context of medical billing
and coding?
To identify the correct coding errors before claim submissions
Dr. Smith's office received a request from John Does insurance company for his medical
records to process a claim. According to HIPPA regulations, what is the most appropriate
action for Dr. Smith's office to take?
,Provide only the minimum necessary information required to process the claim
When coding for Obstetrics, which of the following codes is used to indicate a routine
prenatal visit with no complications?
- Z34.00: Routine prenatal for normal first pregnancy no complications
- O09.89: Supervision of high risk pregnancy
- Z33.1: Encounter for pregnancy test
- O10.11: Pre-existing hypertension complicating pregnancy
Z34.00: Routine prenatal for normal first pregnancy no complications
Sarah, a patient. has recently filled for bankruptcy. As a medical billing specialist, what is the
appropriate action to take regarding her outstanding medical bills?
Cease all collection activities and notify the bankruptcy court
When coding for telemedicine services, which modifier should be appended to indicate the
service was provided via Telehealth?
Modifier 95
When a patient has multiple insurance plans, which insurance plan is typically considered
the primary insurance?
The insurance plan provided by the patients employer
Sarah, a medical billing specialist, is verifying insurance eligibility for a patient named John
who has a commercial insurance plan. Which of the following is a requirement she must
fulfill to ensure that John's insurance eligibility is verified correctly?
Confirm the patient's policy number and group number
Which of the following is the most crucial step in ensuring all applicable charges are
captured for optimal reimbursement?
Reviewing patient encounter forms and progress notes
Sarah, a patient with a PPO insurance plan, needs to undergo a specialized surgery. Her
preferred surgeon is out-of-network. Which of the following steps should Sarah take to
understand her out-of-network coverage and potential costs?
Contact her insurance company to verify out-of-network benefits and obtain
pre-authorization
What is the first step in the insurance eligibility and benefits verification process?
Verifying a patient's insurance coverage
, Sarah visits her primary care physician for a routine check-up. Her insurance plan has 20%
coinsurance rate after meeting a $200 deductible. The total bill for the visit is $500 , and
Sarah has already met her deductible for the year.How much is Sarah responsible for paying
out-of-pocket for this visit?
- $100
- $200
- $300
- $400
$100
When coding for a total knee arthroplasty in an orthopedic speciality, which of the following
CPT codes is the most appropriate?
27447
What is the primary purpose of a deductible in a health insurance policy?
To ensure the patient shares in the cost of their healthcare services
Which of the following government insurance plans primarily covers individuals aged 65 and
older, as well as certain individuals with disabilities?
Medicare
Mr. Johnson, a 68-year old patient, is enrolled in Medicare. He needs a comprehensive
understanding of his coverage options. Which part of Medicare will cover his inpatient
hospital stay if he is admitted for a surgical procedure?
Medicare Part A
Dr. Smith performed a laparoscopic cholecystectomy on a 45-year old patient named John
Doe. The procedure was uncomplicated, and the patient was discharged the same day.
Which CPT code should be used to accurately represent the procedure?
47562: Uncomplicated laparoscopic cholecystectomy
Sarah, a medical billing and coding specialist, is verifying insurance eligibility for a new
patient, John Doe, who has recently switched to a new insurance provider. What is the most
crucial piece of documentation Sarah needs to ensure John's insurance coverage is valid
before proceeding with the billing process?
A copy of John's new insurance card
Dr. Smith is submitting a CMS-1500 claim form for his patient John Doe, who received
outpatient services. Which field should Dr. Smith use to indicate the diagnoses code for John
Doe's condition?
