NHA CBCS Exam () Actual Questions and Verified
Answers & Rationales / A+ Grade 100% Guarantee
Which of the following actions should the CBCS take to prevent fraud and abuse in the
medical office?
-Serviced procedure preauthorization
-Internal monitoring and auditing
-Utilization review
-Correct coding initiative - Internal monitoring and auditing
In an outpatient setting, which of the following forms is used as a financial report of all
services provided to patients?
-Encounter form
-Patient account record
-CMS-1500 claim form
-Accounts receivable journal - Patient account record (patient ledger, all transactions
between patient and the practice)
-Accounts receivable journal (Day sheet = chronological summary of all transaction on a
specific day)
Patient charges that have not been paid will appear in which of the following?
-Accounts receivable
-Accounts payable
-Tracer
-Rejected claim - Accounts receivable
Which of the following is considered the final determination of the issues involving
settlement of an insurance claim?
-Processing
-Translation
-Adjudication
-Transmission - Adjudication (process of putting a claim through a series of edits for
final determination)
-Processing ( handling a claim from the first encounter to claim submission)
-Translation (claim is send from the host system to the clearing house)
-Transmission (how the claim was sent)
Which of the following information should the CBCS input into block 33a on the CMS-
1500 claim form
-Provider social security number (no Social security number on CMS1500)
-Federal tax id number (entered in block 25)
-Patient id number (on block 1a)
-National provider identification number - National provider identification number
,A prospective billing account audit prevents fraud by reviewing and comparing a
completed claim form with which of the following documents?
-A billing worksheet from the patient account
-A superbill
-A day sheet
-Am accounts receivable report of the patient account - A billing worksheet from the
patient account
When a patient has a condition that is both acute and chronic, how should it be
reported?
-Code only the acute code
-Code both acute and chronic, sequencing the acute first
-Code only the chronic code
-Code both acute and chronic, sequencing the chronic first - Code both acute and
chronic, sequencing the acute first
Which of the following types of health insurance plan best describes a government
sponsored benefit program?
-Unemployment compensation disability
-TRICARE prime
-Foundation for Medicare
-Worker's compensation - TRICARE prime
-Unemployment compensation disability (state insurance covering non work related
illness and injury)
Accepting assignment on the CMS-1500 claim form indicates which of the following?
-The patient agrees to accept payment and forward the payment to the physician
-The physician agrees to accept payment under the terms of the payer's program.
-The physician agrees to bill according the third payer's fee schedule
-The patient agrees to pay the difference between the billed amount and the allowed
amount - The physician agrees to accept payment under the terms of the payer's
program.
Which of the following parts of the body system regulates immunity?
-Endocrine system (regulates growth, metabolic)
-Respiratory system (removes carbon dioxide)
-Urinary system (filters blood to remove waste of cellular metabolism)
-Lymphatic system - Lymphatic system
-Endocrine system (regulates growth, metabolic)
-Respiratory system (removes carbon dioxide)
-Urinary system (filters blood to remove waste of cellular metabolism)
Which of the following sections of the medical record is used to determine the correct
evaluation and management code to use for billing and coding?
-Codes used during prior patient visits
,-Patient's insurance plan
-Plan of care
-History and physical - History and physical
A patient's health plan is referred to as the payer of last resort. The patient is covered by
which of the following health plans?
Medicaid
CHAMPA
Medicare
TRICARE - Medicaid
A provider charged $500 to a claim that had an allowable amount of $400. In which of
the following columns should the CBCS apply the non allowed charge?
-Reference column (For notations)
-Description column
-Payment column
-Adjustment column of the credits - Adjustment column of the credits
Which of the following statements is correct regarding a deductible?
-Coinsurance is a type of deductible
-The physician should write off the deductible
-The insurance company pays for the deductible
-The deductible is the patient's responsibility - The deductible is the patient's
responsibility
Which of the following color formats allows optical scanning of the CMS-1500 claim
form?
-Red
-Blue
-Green
-black - red
Ambulatory surgery centers, home health and hospice organizations use the ______.
-CMS-1500 claim form
-UB-04 claim form
-Advance Beneficiary notice
-First report of injury form - UB-04
Claims that are submitted without an NPI number will delay payment to the provider
because ______.
-The number is the patient' id number
-The number is needed to identify the provider
-Is is used as a claim number
-It is used as a pre authorization number - The number is needed to identify the provider
, Which of the following terms describes when a plan pays 70% of the allowed amount
and the patient pays 30%?
-Coinsurance
-Deductible
-Premium
-copayment - coinsurance
Which of the following indicates a claim should be submitted on paper instead of
electronically?
-The software claims review process indicates the claim is not complete
-The claim needs authorization
-The claim requires an attachment
-The practice management software is non functional. - the claim requires an
attachment
On a remittance advice form, which of the following is responsible for writing off the
difference between the amount billed and the amount allowed by the agreement?
-Provider
-Insurance company
-Patient
-Third party payer - provider
A physician is contracted with an insurance company to accept the amount. The
insurance company allows $80 of a $120 billed amount, and $50 of the deductible has
not been met. How much should the physician write off the patient's account?
-$40
-$15
-$0
-$50 - $40
The unlisted codes can be found in which of the following locations in the CPT manual?
-Appendix L
-Guidelines prior to each section
-End of each body system
-Table of contents - Guidelines prior to each section
Which of the following blocks should the billing and coding specialist complete the CMS
1500 claims form for procedure, services or supplies?
-Block 12
-Block 2
-Block 24D
-Block 24J - Block 24D
-Block 12 (patient's authorization block
-Block 2 ( patient's name)
-Block 24J ( for the rendering provider)
Answers & Rationales / A+ Grade 100% Guarantee
Which of the following actions should the CBCS take to prevent fraud and abuse in the
medical office?
-Serviced procedure preauthorization
-Internal monitoring and auditing
-Utilization review
-Correct coding initiative - Internal monitoring and auditing
In an outpatient setting, which of the following forms is used as a financial report of all
services provided to patients?
-Encounter form
-Patient account record
-CMS-1500 claim form
-Accounts receivable journal - Patient account record (patient ledger, all transactions
between patient and the practice)
-Accounts receivable journal (Day sheet = chronological summary of all transaction on a
specific day)
Patient charges that have not been paid will appear in which of the following?
-Accounts receivable
-Accounts payable
-Tracer
-Rejected claim - Accounts receivable
Which of the following is considered the final determination of the issues involving
settlement of an insurance claim?
-Processing
-Translation
-Adjudication
-Transmission - Adjudication (process of putting a claim through a series of edits for
final determination)
-Processing ( handling a claim from the first encounter to claim submission)
-Translation (claim is send from the host system to the clearing house)
-Transmission (how the claim was sent)
Which of the following information should the CBCS input into block 33a on the CMS-
1500 claim form
-Provider social security number (no Social security number on CMS1500)
-Federal tax id number (entered in block 25)
-Patient id number (on block 1a)
-National provider identification number - National provider identification number
,A prospective billing account audit prevents fraud by reviewing and comparing a
completed claim form with which of the following documents?
-A billing worksheet from the patient account
-A superbill
-A day sheet
-Am accounts receivable report of the patient account - A billing worksheet from the
patient account
When a patient has a condition that is both acute and chronic, how should it be
reported?
-Code only the acute code
-Code both acute and chronic, sequencing the acute first
-Code only the chronic code
-Code both acute and chronic, sequencing the chronic first - Code both acute and
chronic, sequencing the acute first
Which of the following types of health insurance plan best describes a government
sponsored benefit program?
-Unemployment compensation disability
-TRICARE prime
-Foundation for Medicare
-Worker's compensation - TRICARE prime
-Unemployment compensation disability (state insurance covering non work related
illness and injury)
Accepting assignment on the CMS-1500 claim form indicates which of the following?
-The patient agrees to accept payment and forward the payment to the physician
-The physician agrees to accept payment under the terms of the payer's program.
-The physician agrees to bill according the third payer's fee schedule
-The patient agrees to pay the difference between the billed amount and the allowed
amount - The physician agrees to accept payment under the terms of the payer's
program.
Which of the following parts of the body system regulates immunity?
-Endocrine system (regulates growth, metabolic)
-Respiratory system (removes carbon dioxide)
-Urinary system (filters blood to remove waste of cellular metabolism)
-Lymphatic system - Lymphatic system
-Endocrine system (regulates growth, metabolic)
-Respiratory system (removes carbon dioxide)
-Urinary system (filters blood to remove waste of cellular metabolism)
Which of the following sections of the medical record is used to determine the correct
evaluation and management code to use for billing and coding?
-Codes used during prior patient visits
,-Patient's insurance plan
-Plan of care
-History and physical - History and physical
A patient's health plan is referred to as the payer of last resort. The patient is covered by
which of the following health plans?
Medicaid
CHAMPA
Medicare
TRICARE - Medicaid
A provider charged $500 to a claim that had an allowable amount of $400. In which of
the following columns should the CBCS apply the non allowed charge?
-Reference column (For notations)
-Description column
-Payment column
-Adjustment column of the credits - Adjustment column of the credits
Which of the following statements is correct regarding a deductible?
-Coinsurance is a type of deductible
-The physician should write off the deductible
-The insurance company pays for the deductible
-The deductible is the patient's responsibility - The deductible is the patient's
responsibility
Which of the following color formats allows optical scanning of the CMS-1500 claim
form?
-Red
-Blue
-Green
-black - red
Ambulatory surgery centers, home health and hospice organizations use the ______.
-CMS-1500 claim form
-UB-04 claim form
-Advance Beneficiary notice
-First report of injury form - UB-04
Claims that are submitted without an NPI number will delay payment to the provider
because ______.
-The number is the patient' id number
-The number is needed to identify the provider
-Is is used as a claim number
-It is used as a pre authorization number - The number is needed to identify the provider
, Which of the following terms describes when a plan pays 70% of the allowed amount
and the patient pays 30%?
-Coinsurance
-Deductible
-Premium
-copayment - coinsurance
Which of the following indicates a claim should be submitted on paper instead of
electronically?
-The software claims review process indicates the claim is not complete
-The claim needs authorization
-The claim requires an attachment
-The practice management software is non functional. - the claim requires an
attachment
On a remittance advice form, which of the following is responsible for writing off the
difference between the amount billed and the amount allowed by the agreement?
-Provider
-Insurance company
-Patient
-Third party payer - provider
A physician is contracted with an insurance company to accept the amount. The
insurance company allows $80 of a $120 billed amount, and $50 of the deductible has
not been met. How much should the physician write off the patient's account?
-$40
-$15
-$0
-$50 - $40
The unlisted codes can be found in which of the following locations in the CPT manual?
-Appendix L
-Guidelines prior to each section
-End of each body system
-Table of contents - Guidelines prior to each section
Which of the following blocks should the billing and coding specialist complete the CMS
1500 claims form for procedure, services or supplies?
-Block 12
-Block 2
-Block 24D
-Block 24J - Block 24D
-Block 12 (patient's authorization block
-Block 2 ( patient's name)
-Block 24J ( for the rendering provider)
