4/12/25, 8:24 NHA CBCS |
PM
NHA CBCS EXAM QUESTIONS AND ANSWERS WITH
COMPLETE SOLUTIONS VERIFIED LATEST UPDATE
Practice questions for this set
Learn 1/7 Study using Learn
specifically prohibits any payment by Medicare for services or medically necessary
supplies that are not submitted electronically
Select the correct term
Administration Simplification Compliance
1Correction And Renewal
2Act
Don't know?
Terms in this set (129)
The extraction of specific data from a medical record, often for use in
abstracting
an external database, such as a cancer registry.
practices that directly or indirectly result in unnecessary costs to the
abuse
Medicare program
account number Number that identifies specific episode of care, date of service, or patient.
Department that keeps track of what third-party payers the provider is
accounts receivable department
waiting to hear from and what patients are due to make a payment.
activity/status date Indicates the most recent activity of an item.
actual charge The amount the provider charges for the health care service.
Administration Simplification specifically prohibits any payment by Medicare for services or
Compliance Act medically necessary supplies that are not submitted
electronically
Contract between employers and private insurers under which
administrative services only contract employers fund the plans themselves, and the private insurance
administers the plans for
employees.
balance billing Billing patients for charges in excess of the Medicare fee schedule.
batch a group of submitted claims
The first prepaid plan in the U.S. that offers health insurance to
Blue Cross and Blue Shield plan
individuals, small businesses, seniors, and large employer groups.
Individuals, groups, or organizations, who are not members of a
business associate
covered entity's workforce, that perform functions or activities on
behalf of or for a covered entity.
Advance Beneficiary Notice of Form provided if a provider believes that a service may be declined
Noncoverage (ABN) because Medicare might consider it unnecessary.
aging report Measures the outstanding balances in each account.
allowable charge The amount an insurer will accept as full payment, minus applicable cost sharing.
1/
5
, 4/12/25, 8:24 NHA CBCS |
PM
Helps coders determine the appropriate ambulatory payment
APC grouper
classification (APC) for an outpatient encounter.
Contract in which the provider directly bills the payer and accepts the
assignment of benefits
allowable charge.
auditing Review of claims for accuracy and completeness.
Permission granted by the patient or the patient's representative to release
authorization
information for reasons other than treatment, payment, or health care operations.
capitation The fixed amount a provider receives.
case management a review of clinical services being performed
category I cpt code Code that covers physicians' services and hospital outpatient coding.
Code designed to serve as supplemental tracking codes that can be
category II cpt code
used for performance measurement.
Code used for temporary coding for new technology and services
category III cpt code
that have not met the requirements needed to be added to the main
section of the CPT book.
charge amount The amount the facility charges for the procedure or service.
Information about health care services that patients have received
charge description master
and financial transactions that have taken place.
charge or service code Internally assigned number unique to each facility
a complete record of services provided by a health care professional,
claim along with appropriate insurance information, submitted for
reimbursement to a third-party payer
claims adjustment reason code provides financial information about claims decisions
software that receives a claim prior to submission for correct and
claim scrubber complete data, such as accurate gender in alignment with
diagnosis/procedure or medical necessity
Claim that is accurate and complete. They have all the information
clean claim
needed for processing, which is done in a timely fashion.
Agency that converts claims into a standardized electronic format,
clearinghouse
looks for errors, and formats them according to HIPAA and insurance
standards.
The record of clinical observations and care a patient receives at a
clinical documentation
health care facility.
commercial insurance Private and employer-based self-insurance
Software that scans the entire patient's electronic record and
computer-assisted coding
codes the encounter based on the documentation in the
record.
conditional payment Medicare payment that is recovered after primary insurance pays.
consent a patient's permission evidenced by signature
contractural obligation used when a contractural agreement resulted in an adjustment
coordination of benefits rules Determines which insurance plan is primary and which is secondary.
correction and renewal used for correcting a prior claim
cost sharing The balance the policyholder must pay to the provider.
crossover claim Claim submitted by people covered by a primary and secondary insurance plan.
Information that does not identify an individual because unique and
de-identified information
personal characteristics have been removed.
Date of birth, sex, marital status, address, telephone number,
demographic information
relationship to subscriber, and circumstances of condition.
2/
5
PM
NHA CBCS EXAM QUESTIONS AND ANSWERS WITH
COMPLETE SOLUTIONS VERIFIED LATEST UPDATE
Practice questions for this set
Learn 1/7 Study using Learn
specifically prohibits any payment by Medicare for services or medically necessary
supplies that are not submitted electronically
Select the correct term
Administration Simplification Compliance
1Correction And Renewal
2Act
Don't know?
Terms in this set (129)
The extraction of specific data from a medical record, often for use in
abstracting
an external database, such as a cancer registry.
practices that directly or indirectly result in unnecessary costs to the
abuse
Medicare program
account number Number that identifies specific episode of care, date of service, or patient.
Department that keeps track of what third-party payers the provider is
accounts receivable department
waiting to hear from and what patients are due to make a payment.
activity/status date Indicates the most recent activity of an item.
actual charge The amount the provider charges for the health care service.
Administration Simplification specifically prohibits any payment by Medicare for services or
Compliance Act medically necessary supplies that are not submitted
electronically
Contract between employers and private insurers under which
administrative services only contract employers fund the plans themselves, and the private insurance
administers the plans for
employees.
balance billing Billing patients for charges in excess of the Medicare fee schedule.
batch a group of submitted claims
The first prepaid plan in the U.S. that offers health insurance to
Blue Cross and Blue Shield plan
individuals, small businesses, seniors, and large employer groups.
Individuals, groups, or organizations, who are not members of a
business associate
covered entity's workforce, that perform functions or activities on
behalf of or for a covered entity.
Advance Beneficiary Notice of Form provided if a provider believes that a service may be declined
Noncoverage (ABN) because Medicare might consider it unnecessary.
aging report Measures the outstanding balances in each account.
allowable charge The amount an insurer will accept as full payment, minus applicable cost sharing.
1/
5
, 4/12/25, 8:24 NHA CBCS |
PM
Helps coders determine the appropriate ambulatory payment
APC grouper
classification (APC) for an outpatient encounter.
Contract in which the provider directly bills the payer and accepts the
assignment of benefits
allowable charge.
auditing Review of claims for accuracy and completeness.
Permission granted by the patient or the patient's representative to release
authorization
information for reasons other than treatment, payment, or health care operations.
capitation The fixed amount a provider receives.
case management a review of clinical services being performed
category I cpt code Code that covers physicians' services and hospital outpatient coding.
Code designed to serve as supplemental tracking codes that can be
category II cpt code
used for performance measurement.
Code used for temporary coding for new technology and services
category III cpt code
that have not met the requirements needed to be added to the main
section of the CPT book.
charge amount The amount the facility charges for the procedure or service.
Information about health care services that patients have received
charge description master
and financial transactions that have taken place.
charge or service code Internally assigned number unique to each facility
a complete record of services provided by a health care professional,
claim along with appropriate insurance information, submitted for
reimbursement to a third-party payer
claims adjustment reason code provides financial information about claims decisions
software that receives a claim prior to submission for correct and
claim scrubber complete data, such as accurate gender in alignment with
diagnosis/procedure or medical necessity
Claim that is accurate and complete. They have all the information
clean claim
needed for processing, which is done in a timely fashion.
Agency that converts claims into a standardized electronic format,
clearinghouse
looks for errors, and formats them according to HIPAA and insurance
standards.
The record of clinical observations and care a patient receives at a
clinical documentation
health care facility.
commercial insurance Private and employer-based self-insurance
Software that scans the entire patient's electronic record and
computer-assisted coding
codes the encounter based on the documentation in the
record.
conditional payment Medicare payment that is recovered after primary insurance pays.
consent a patient's permission evidenced by signature
contractural obligation used when a contractural agreement resulted in an adjustment
coordination of benefits rules Determines which insurance plan is primary and which is secondary.
correction and renewal used for correcting a prior claim
cost sharing The balance the policyholder must pay to the provider.
crossover claim Claim submitted by people covered by a primary and secondary insurance plan.
Information that does not identify an individual because unique and
de-identified information
personal characteristics have been removed.
Date of birth, sex, marital status, address, telephone number,
demographic information
relationship to subscriber, and circumstances of condition.
2/
5
