NHA CBCS Practice Questions (Set 1) and Answers Graded A+
What is the first step in verifying a patient's insurance Review the patient's insurnace card for policy number and
information? group number
What is the most crucial step in verifying a patient's insur- Verifying a patients eligibility and benefits directly with the
ance information before providing medical services? insurance company
Which of the following is a primary characteristic of work- They cover medical expenses and lost wages due to work
ers' compensation plans? related injuries
What is the primary step a medical billing and coding
Review the Explanation of benefits (EOB) to determine the
specialist should take when a claim is denied by a third
reason for denial
party payer?
When filling a claim with multiple insurance carriers,
The primary insurance of the patient
which insurance should be billed first?
When coding from an operative report, which section
typically contains the most detailed description of surgical Operative note
procedure performed?
What is the primary purpose of the explanation of ben-
To outline the patient's payment responsibilities and the
efits (EOB) document in the revenue cycle management
payer's payment decisions
process?
Dr. Smith's clinic has recently implemented a compliance
plan to ensure adherence regulatory standards. During an
internal audit, it was discovered that an overpayment was
received from Medicare for services rendered to a patient
Report the overpayment to Medicare within 60 days
named John Doe.
According to the Provider Self-Disclosure Protocol (SDP),
what is the appropriate action Dr. Smith's clinic should
take?
Sarah a medical billing and coding specialist is reviewing
a claim that was denied by a third-party payer due-to Appeal the denial with supporting documentation from
"lack of medical necessity." Which of the following actions the patient's medical record
should Sarah take to address this denial?
,NHA CBCS Practice Questions (Set 1) and Answers Graded A+
John, a 45 year-old employee at a manufacturing compa-
ny is reviewing this employee-sponsored health insurance
options. He notices that one of the plans is a Preferred
Provider Organization (PPO) while another is a Health Preferred Provider Organization (PPO)
Maintenance Organization (HMO). John values having the
flexibility to see specialists without needing a referral.
Which plan should choose to best meet his needs?
During the pre-authorization process for a complex surgi-
cal procedure, the insurance company request additional
documentation or verify medical necessity. As the medical Schedule a meeting with Dr. Smith to discuss the specific
billing specialists, how should you clearly and accurately documents required and their importance.
communicate this requirement to Dr. Smith, the surgeon,
to ensure timely compliance?
Doctor Smith submitted a claim for a patient named John
Doe, who under went a minor surgical procedure. The
claim was denied due to a code edit indicating a bundling Review the National Correct Coding Initiative (NCCI) Edits
issue. What should the medical biller do first to resolve
this issue?
John a patient is undergoing treatment for a chronic con-
dition. During the visit, the healthcare provider discusses
the importance of accurately documenting his treatment
plan and communicating it with the billing department to Verifying that all treatment codes are entered correctly into
ensure proper coding and reimbursement. Which of the the Electronic Health Record (EHR).
following steps is most crucial in maintaining regulatory
compliance and ensuring accurate communication with
stakeholders throughout the revenue cycle?
What is the purpose of Local Coverage Determination
To define specific coverage criteria for services at the local
(LCD) in the context of medical billing and reimburse-
level
ment?
, NHA CBCS Practice Questions (Set 1) and Answers Graded A+
When is it important to issue an Advanced Beneficiary When the provider believes Medicare will likely deny pay-
Notice (ABN) to a Medicare patient? ment for a service
What is the primary limitation of Medicare Part B coverage It requires beneficiaries to pay an annual deductible and
for out patient services? 20% coinsurance for most services
Doctor Smith administered general anesthesia to a 45
year old patient, John Doe, for a complex abdominal
surgery that lasted 3 hours. Which CPT code should be 00860
used to accurately report the anesthesia services provid-
ed?
Sarah a medical billing specialists, is reviewing a a pa-
tient's insurance claim for a recent surgery. She notices
Verify the correct procedure code with the healthcare
that the procedure code used does not match the doc-
provider
umentation in the patients medical record. What should
Sarah do first to ensure the claim is processed correctly?
Which of the following actions would most likely constitute
a violation of the False Claims Act in the context of medical Submitting a claim for a service that was not provided.
billing and coding?
When filling a claim with multiple insurance payers, which The insurance plan that covers the patient as an employee
rule should be followed to determine primary payer? is typically the primary payer.
Dr. Smith orders a comprehensive metabolic panel (CMP)
for his patient, John Doe, who is experiencing unexplained
80053 (Comprehensive Metabolic Panel)
fatigue and weight loss. Which CPT code should be used
to accurately bill for this laboratory test?
During the billing process for patient John Smith, the
billing specialist is required to handle various pieces of in-
Patients phone number
formation. Which of the following is considered Protected
Health Information (PHI) under HIPPA regulations?
Maria, an uninsured patient, visits a healthcare facility
for a routine check-up. As a medical billing and coding
What is the first step in verifying a patient's insurance Review the patient's insurnace card for policy number and
information? group number
What is the most crucial step in verifying a patient's insur- Verifying a patients eligibility and benefits directly with the
ance information before providing medical services? insurance company
Which of the following is a primary characteristic of work- They cover medical expenses and lost wages due to work
ers' compensation plans? related injuries
What is the primary step a medical billing and coding
Review the Explanation of benefits (EOB) to determine the
specialist should take when a claim is denied by a third
reason for denial
party payer?
When filling a claim with multiple insurance carriers,
The primary insurance of the patient
which insurance should be billed first?
When coding from an operative report, which section
typically contains the most detailed description of surgical Operative note
procedure performed?
What is the primary purpose of the explanation of ben-
To outline the patient's payment responsibilities and the
efits (EOB) document in the revenue cycle management
payer's payment decisions
process?
Dr. Smith's clinic has recently implemented a compliance
plan to ensure adherence regulatory standards. During an
internal audit, it was discovered that an overpayment was
received from Medicare for services rendered to a patient
Report the overpayment to Medicare within 60 days
named John Doe.
According to the Provider Self-Disclosure Protocol (SDP),
what is the appropriate action Dr. Smith's clinic should
take?
Sarah a medical billing and coding specialist is reviewing
a claim that was denied by a third-party payer due-to Appeal the denial with supporting documentation from
"lack of medical necessity." Which of the following actions the patient's medical record
should Sarah take to address this denial?
,NHA CBCS Practice Questions (Set 1) and Answers Graded A+
John, a 45 year-old employee at a manufacturing compa-
ny is reviewing this employee-sponsored health insurance
options. He notices that one of the plans is a Preferred
Provider Organization (PPO) while another is a Health Preferred Provider Organization (PPO)
Maintenance Organization (HMO). John values having the
flexibility to see specialists without needing a referral.
Which plan should choose to best meet his needs?
During the pre-authorization process for a complex surgi-
cal procedure, the insurance company request additional
documentation or verify medical necessity. As the medical Schedule a meeting with Dr. Smith to discuss the specific
billing specialists, how should you clearly and accurately documents required and their importance.
communicate this requirement to Dr. Smith, the surgeon,
to ensure timely compliance?
Doctor Smith submitted a claim for a patient named John
Doe, who under went a minor surgical procedure. The
claim was denied due to a code edit indicating a bundling Review the National Correct Coding Initiative (NCCI) Edits
issue. What should the medical biller do first to resolve
this issue?
John a patient is undergoing treatment for a chronic con-
dition. During the visit, the healthcare provider discusses
the importance of accurately documenting his treatment
plan and communicating it with the billing department to Verifying that all treatment codes are entered correctly into
ensure proper coding and reimbursement. Which of the the Electronic Health Record (EHR).
following steps is most crucial in maintaining regulatory
compliance and ensuring accurate communication with
stakeholders throughout the revenue cycle?
What is the purpose of Local Coverage Determination
To define specific coverage criteria for services at the local
(LCD) in the context of medical billing and reimburse-
level
ment?
, NHA CBCS Practice Questions (Set 1) and Answers Graded A+
When is it important to issue an Advanced Beneficiary When the provider believes Medicare will likely deny pay-
Notice (ABN) to a Medicare patient? ment for a service
What is the primary limitation of Medicare Part B coverage It requires beneficiaries to pay an annual deductible and
for out patient services? 20% coinsurance for most services
Doctor Smith administered general anesthesia to a 45
year old patient, John Doe, for a complex abdominal
surgery that lasted 3 hours. Which CPT code should be 00860
used to accurately report the anesthesia services provid-
ed?
Sarah a medical billing specialists, is reviewing a a pa-
tient's insurance claim for a recent surgery. She notices
Verify the correct procedure code with the healthcare
that the procedure code used does not match the doc-
provider
umentation in the patients medical record. What should
Sarah do first to ensure the claim is processed correctly?
Which of the following actions would most likely constitute
a violation of the False Claims Act in the context of medical Submitting a claim for a service that was not provided.
billing and coding?
When filling a claim with multiple insurance payers, which The insurance plan that covers the patient as an employee
rule should be followed to determine primary payer? is typically the primary payer.
Dr. Smith orders a comprehensive metabolic panel (CMP)
for his patient, John Doe, who is experiencing unexplained
80053 (Comprehensive Metabolic Panel)
fatigue and weight loss. Which CPT code should be used
to accurately bill for this laboratory test?
During the billing process for patient John Smith, the
billing specialist is required to handle various pieces of in-
Patients phone number
formation. Which of the following is considered Protected
Health Information (PHI) under HIPPA regulations?
Maria, an uninsured patient, visits a healthcare facility
for a routine check-up. As a medical billing and coding
