4/12/25, 8:28
PM
NHA - CERTIFIED BILLING AND CODING SPECIALIST (CBCS)
STUDY GUIDE EXAM QUESTIONS AND ANSWERS
WITH COMPLETE SOLUTIONS VERIFIED LATEST
UPDATE
40 studiers today 4.7 (53 reviews)
Save
Terms in this set (153)
The symbol "O" in the Current Procedural Reinstated or recycled code
Terminology reference is used to
indicate what?
In the anesthesia section of the CPT Add-on codes
manual, what are considered qualifying
circumstances?
As of April 1, 2014 what is the maximum 12
number of diagnoses that can be
reported on the CMS-1500 claim form
before a further claim is required?
What is considered proper supportive Operative report
documentation for reporting CPT and ICD
codes for surgical procedures?
What action should be taken first when Verify the age of the account
reviewing a delinquent claim?
A claim can be denied or rejected for Block 24D contains the diagnosis code
which of the following reasons?
A coroner's autopsy is comprised of what Gross Examination
examinations?
Medigap coverage is offered to Medicare Private third-party payers
beneficiaries by whom?
What part of Medicare Part C
covers prescriptions?
What plane divides the body into left and Sagittal
right?
Where can unlisted codes be found in the Guidelines prior to each section
CPT manual?
Ambulatory surgery centers, home health UB-04 Claim Form
care, and hospice organizations use
which form to submit claims?
What color format is acceptable on the Red
CMS-1500 claim form?
Who is responsible to pay the Patient
deductible?
A patient's health plan is referred to as Medicaid
the "payer of last resort." What is the
name of that health plan?
1/
5
, 4/12/25, 8:28
PM
Providers explain medical or diagnostic procedures, surgical interventions, and
Informed Consent the benefits and risks involved, giving patients an opportunity to ask questions
before medical intervention is provided.
A patient presents for treatment, such as extending an arm to allow a
Implied Consent
venipuncture to be performed.
Agency that converts claims into standardized electronic format, looks for errors,
Clearinghouse
and formats them according to HIPAA and insurance standards.
Documents that identify the person or provide enough information so that the
Individually Identifiable
person can be identified.
Information that does not identify an individual because unique and personal
De-identified Information
characteristics have been removed.
Consent A patient's permission evidenced by signature.
Permission granted by the patient or the patient's representative to release
Authorizations
information for reasons other than treatment, payment, or health care operations.
Reimbursement Payment for services rendered from a third-party payer.
Auditing Review of claims for accuracy and completeness.
Making false statements of representations of material facts to obtain some
Fraud
benefit or payment for which no entitlement would otherwise exist.
Assigning a diagnosis or procedure code at a higher level than the documentation
Upcoding
supports, such as coding bronchitis as pneumonia.
Using multiple codes that describe different components of a treatment instead of
Unbundling
using a single code that describes all steps of the procedure.
Practices that directly or indirectly result in unnecessary costs to the Medicare
Abuse
program.
Individuals, groups, or organizations who are not members of a covered entity's
Business Associate (BA)
workforce that perform functions or activities on behalf of or for a covered entity.
What is the main job of the Office of the The OIG protects Medicare and other HHS programs from fraud and abuse by
Inspector General (OIG)? conducting audits, investigations , and inspections.
Federally funded health insurance provided to people age 65 or older, and
Medicare
people 65 and younger with certain disabilities.
A government-based health insurance option that pays for medical assistance
Medicaid
for individuals who have low incomes and limited financial resources.
Timely Filing Requirements Within 1 calendar year of a claim's date of service.
Electronic Data Interchange (EDI) The transfer of electronic information in a standard form.
Coordination of Benefits Rules Determines which insurance plan is primary and which is secondary.
Conditional Payment Medicare payment that is recovered after primary insurance pays.
Crossover Claim Claim submitted by people covered by a primary and secondary insurance plan.
Contract in which the provider directly bills the payer and accepts the allowable
Assignment of Benefits
charge.
Allowable Charge The amount an insurer will accept as full payment, minus applicable cost sharing.
Claim that is accurate and complete. They have all the information needed for
Clean Claim
processing, which is done in a timely fashion.
Dirty Claim Claim that is inaccurate, incomplete, or contains other errors.
Medicare Administrative Contractor Processes Medicare Parts A and B claims from hospitals, physicians, and other
(MAC) providers.
The report sent from the third-party payer to the provider that reflects any
Remittance Advice (RA)
changes made to the original billing.
Explanation of Benefits (EOB) Describes the services rendered, payment covered, and benefit limits and denials.
2/
5
PM
NHA - CERTIFIED BILLING AND CODING SPECIALIST (CBCS)
STUDY GUIDE EXAM QUESTIONS AND ANSWERS
WITH COMPLETE SOLUTIONS VERIFIED LATEST
UPDATE
40 studiers today 4.7 (53 reviews)
Save
Terms in this set (153)
The symbol "O" in the Current Procedural Reinstated or recycled code
Terminology reference is used to
indicate what?
In the anesthesia section of the CPT Add-on codes
manual, what are considered qualifying
circumstances?
As of April 1, 2014 what is the maximum 12
number of diagnoses that can be
reported on the CMS-1500 claim form
before a further claim is required?
What is considered proper supportive Operative report
documentation for reporting CPT and ICD
codes for surgical procedures?
What action should be taken first when Verify the age of the account
reviewing a delinquent claim?
A claim can be denied or rejected for Block 24D contains the diagnosis code
which of the following reasons?
A coroner's autopsy is comprised of what Gross Examination
examinations?
Medigap coverage is offered to Medicare Private third-party payers
beneficiaries by whom?
What part of Medicare Part C
covers prescriptions?
What plane divides the body into left and Sagittal
right?
Where can unlisted codes be found in the Guidelines prior to each section
CPT manual?
Ambulatory surgery centers, home health UB-04 Claim Form
care, and hospice organizations use
which form to submit claims?
What color format is acceptable on the Red
CMS-1500 claim form?
Who is responsible to pay the Patient
deductible?
A patient's health plan is referred to as Medicaid
the "payer of last resort." What is the
name of that health plan?
1/
5
, 4/12/25, 8:28
PM
Providers explain medical or diagnostic procedures, surgical interventions, and
Informed Consent the benefits and risks involved, giving patients an opportunity to ask questions
before medical intervention is provided.
A patient presents for treatment, such as extending an arm to allow a
Implied Consent
venipuncture to be performed.
Agency that converts claims into standardized electronic format, looks for errors,
Clearinghouse
and formats them according to HIPAA and insurance standards.
Documents that identify the person or provide enough information so that the
Individually Identifiable
person can be identified.
Information that does not identify an individual because unique and personal
De-identified Information
characteristics have been removed.
Consent A patient's permission evidenced by signature.
Permission granted by the patient or the patient's representative to release
Authorizations
information for reasons other than treatment, payment, or health care operations.
Reimbursement Payment for services rendered from a third-party payer.
Auditing Review of claims for accuracy and completeness.
Making false statements of representations of material facts to obtain some
Fraud
benefit or payment for which no entitlement would otherwise exist.
Assigning a diagnosis or procedure code at a higher level than the documentation
Upcoding
supports, such as coding bronchitis as pneumonia.
Using multiple codes that describe different components of a treatment instead of
Unbundling
using a single code that describes all steps of the procedure.
Practices that directly or indirectly result in unnecessary costs to the Medicare
Abuse
program.
Individuals, groups, or organizations who are not members of a covered entity's
Business Associate (BA)
workforce that perform functions or activities on behalf of or for a covered entity.
What is the main job of the Office of the The OIG protects Medicare and other HHS programs from fraud and abuse by
Inspector General (OIG)? conducting audits, investigations , and inspections.
Federally funded health insurance provided to people age 65 or older, and
Medicare
people 65 and younger with certain disabilities.
A government-based health insurance option that pays for medical assistance
Medicaid
for individuals who have low incomes and limited financial resources.
Timely Filing Requirements Within 1 calendar year of a claim's date of service.
Electronic Data Interchange (EDI) The transfer of electronic information in a standard form.
Coordination of Benefits Rules Determines which insurance plan is primary and which is secondary.
Conditional Payment Medicare payment that is recovered after primary insurance pays.
Crossover Claim Claim submitted by people covered by a primary and secondary insurance plan.
Contract in which the provider directly bills the payer and accepts the allowable
Assignment of Benefits
charge.
Allowable Charge The amount an insurer will accept as full payment, minus applicable cost sharing.
Claim that is accurate and complete. They have all the information needed for
Clean Claim
processing, which is done in a timely fashion.
Dirty Claim Claim that is inaccurate, incomplete, or contains other errors.
Medicare Administrative Contractor Processes Medicare Parts A and B claims from hospitals, physicians, and other
(MAC) providers.
The report sent from the third-party payer to the provider that reflects any
Remittance Advice (RA)
changes made to the original billing.
Explanation of Benefits (EOB) Describes the services rendered, payment covered, and benefit limits and denials.
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5
