With 100 Multiple choice Exam Questions and Answers
20 pretest Questions
Time limit: 2 hours
, ANSWERS
NHA CBCS EXAM PREP 2025 – STUDY GUIDE AND ANSWERS FOR
CERTIFIED BILLING & CODING SPECIALISTS 1. B
PART 1 (PRETEST QUESTIONS) 2. B
3. B
1. Which of the following Medicare policies determines if a particular item or
service is covered by Medicare? 4. A
A. Advance Beneficiary Notice (ABN) 5. B
B. National Coverage Determination (NCD)
6. B
C. Coordination of Benefits
D. Remittance Advice 7. B
2. A patient's employer has not submitted a premium payment. Which of the 8. B
following claim statuses should the provider receive from the third-party payer? 9. B
A. Pending
10. B
B. Denied
C. Suspended 11. C
D. Paid 12. C
3. A billing and coding specialist should routinely analyze which of the following 13. B
to determine the number of outstanding claims? 14. B
A. Patient ledger
15. B
B. Aging report
C. Remittance advice 16. B
D. Encounter form 17. B
4. Which of the following should a billing and coding specialist use to submit a 18. C
claim with supporting documents?
19. C
A. Claims attachment
B. Precertification form 20. B
C. CMS-1500 claim form 21. C
D. UB-04 claim form
22. B
5. Which of the following terms is used to communicate why a claim line item was 23. A
denied or paid differently than it was billed?
24. B
A. Remark codes
B. Claim adjustment codes 25. B
C. Modifiers
D. Condition codes
S
,6. On a CMS-1500 claim form, which of the following information should the billing and
coding specialist enter into Block 32?
A. Referring provider information
B. Service facility location information
C. Billing provider information
D. Prior authorization number
7. A provider's office receives a subpoena requesting medical documentation from a
patient's medical record. After confirming the correct authorization, which of the following
actions should the billing and coding specialist take?
A. Send the patient's entire medical record.
B. Send the medical information pertaining to the dates of service requested.
C. Contact the patient for verbal consent.
D. Refuse to send the information without a court order.
8. Which of the following is the deadline for Medicare claim submission?
A. 6 months from the date of service
B. 12 months from the date of service
C. 24 months from the date of service
D. 36 months from the date of service
9. Which of the following forms does a third-party payer require for physician services?
A. UB-04
B. CMS-1500
C. HCFA-1450
D. ADA 2012
10. A patient who is an active member of the military recently returned from overseas and
is in need of specialty care. The patient does not have anyone designed with power of
attorney. Which of the following is considered a HIPAA violation?
A. The billing and coding specialist sends the patient's records to the military treatment facility.
B. The billing and coding specialist sends the patient's records to the patient's partner.
C. The billing and coding specialist discusses the case with the provider.
D. The billing and coding specialist verifies the patient's eligibility for benefits.
, 11. Which of the following terms refers to the difference between the billing and allowed
amounts?
A. Deductible
B. Copayment
C. Adjustment
D. Coinsurance
12. Which of the following HMO managed care services requires a referral?
A. Primary care office visit
B. Emergency room services
C. Durable medical equipment
D. Annual physical exam
13. Which of the following explains why Medicare will deny a particular service or
procedure?
A. Remittance Advice (RA)
B. Advance Beneficiary Notice (ABN)
C. Explanation of Benefits (EOB)
D. National Provider Identifier (NPI)
14. Which of the following types of claims is 120 days old?
A. Current
B. Delinquent
C. Suspended
D. Denied
15. When reviewing an established patient's insurance card, the billing and coding
specialist notices a minor change from the existing card on file. Which of the following
actions should the billing and coding specialist take?
A. Ignore the change since it is minor.
B. Photocopy both sides of the new card.
C. Ask the patient if their insurance has changed.
D. Use the old information to file the claim.
20 pretest Questions
Time limit: 2 hours
, ANSWERS
NHA CBCS EXAM PREP 2025 – STUDY GUIDE AND ANSWERS FOR
CERTIFIED BILLING & CODING SPECIALISTS 1. B
PART 1 (PRETEST QUESTIONS) 2. B
3. B
1. Which of the following Medicare policies determines if a particular item or
service is covered by Medicare? 4. A
A. Advance Beneficiary Notice (ABN) 5. B
B. National Coverage Determination (NCD)
6. B
C. Coordination of Benefits
D. Remittance Advice 7. B
2. A patient's employer has not submitted a premium payment. Which of the 8. B
following claim statuses should the provider receive from the third-party payer? 9. B
A. Pending
10. B
B. Denied
C. Suspended 11. C
D. Paid 12. C
3. A billing and coding specialist should routinely analyze which of the following 13. B
to determine the number of outstanding claims? 14. B
A. Patient ledger
15. B
B. Aging report
C. Remittance advice 16. B
D. Encounter form 17. B
4. Which of the following should a billing and coding specialist use to submit a 18. C
claim with supporting documents?
19. C
A. Claims attachment
B. Precertification form 20. B
C. CMS-1500 claim form 21. C
D. UB-04 claim form
22. B
5. Which of the following terms is used to communicate why a claim line item was 23. A
denied or paid differently than it was billed?
24. B
A. Remark codes
B. Claim adjustment codes 25. B
C. Modifiers
D. Condition codes
S
,6. On a CMS-1500 claim form, which of the following information should the billing and
coding specialist enter into Block 32?
A. Referring provider information
B. Service facility location information
C. Billing provider information
D. Prior authorization number
7. A provider's office receives a subpoena requesting medical documentation from a
patient's medical record. After confirming the correct authorization, which of the following
actions should the billing and coding specialist take?
A. Send the patient's entire medical record.
B. Send the medical information pertaining to the dates of service requested.
C. Contact the patient for verbal consent.
D. Refuse to send the information without a court order.
8. Which of the following is the deadline for Medicare claim submission?
A. 6 months from the date of service
B. 12 months from the date of service
C. 24 months from the date of service
D. 36 months from the date of service
9. Which of the following forms does a third-party payer require for physician services?
A. UB-04
B. CMS-1500
C. HCFA-1450
D. ADA 2012
10. A patient who is an active member of the military recently returned from overseas and
is in need of specialty care. The patient does not have anyone designed with power of
attorney. Which of the following is considered a HIPAA violation?
A. The billing and coding specialist sends the patient's records to the military treatment facility.
B. The billing and coding specialist sends the patient's records to the patient's partner.
C. The billing and coding specialist discusses the case with the provider.
D. The billing and coding specialist verifies the patient's eligibility for benefits.
, 11. Which of the following terms refers to the difference between the billing and allowed
amounts?
A. Deductible
B. Copayment
C. Adjustment
D. Coinsurance
12. Which of the following HMO managed care services requires a referral?
A. Primary care office visit
B. Emergency room services
C. Durable medical equipment
D. Annual physical exam
13. Which of the following explains why Medicare will deny a particular service or
procedure?
A. Remittance Advice (RA)
B. Advance Beneficiary Notice (ABN)
C. Explanation of Benefits (EOB)
D. National Provider Identifier (NPI)
14. Which of the following types of claims is 120 days old?
A. Current
B. Delinquent
C. Suspended
D. Denied
15. When reviewing an established patient's insurance card, the billing and coding
specialist notices a minor change from the existing card on file. Which of the following
actions should the billing and coding specialist take?
A. Ignore the change since it is minor.
B. Photocopy both sides of the new card.
C. Ask the patient if their insurance has changed.
D. Use the old information to file the claim.
