HEALTHCARE CERTIFICATION
NHA CBCS Exam Questions and Verified Answers
(2026/2027) 100% Guarantee Pass 2026/2027
A+
Complete Domain Coverage
A+ 5 100%
QUESTIONS VERIFIED CORE DOMAINS COVERED RATIONALES INCLUDED
CATEGORIES
1. Medical Billing Process and Claims Submission
2. Medical Coding Systems ICD-10-CM CPT and HCPCS
3. Insurance Plans Reimbursement and Payer Guidelines
4. Compliance HIPAA Fraud and Abuse Prevention
5. Revenue Cycle Management Patient Accounts and Collections
STUVIAACTUALEXAM
, SECTION 1: MEDICAL BILLING PROCESS AND CLAIMS SUBMISSION
Q1
A billing specialist is preparing a claim for an outpatient encounter. The claim form currently used for professional
services in the United States is the:
A. CMS-1500
B. UB-04
C. CMS-1450
D. ADA Dental Claim
Correct Answer: A
Rationale:
The CMS-1500 is the standard paper claim form for professional (physician) services. The UB-04 (CMS-1450) is used for institutional/facility
claims.
Q2
A patient presents a new insurance card at check-in. The specialist must verify eligibility before the visit to avoid claim
denials. The most reliable method is to:
A. Accept the card as presented without verification
B. Wait until the claim is submitted to discover issues
C. Ask the patient only whether coverage is active
D. Contact the payer via electronic eligibility inquiry or phone verification
Correct Answer: D
Rationale:
Real-time or batch electronic eligibility verification (or phone confirmation) confirms active coverage, benefits, and patient responsibility before
services are rendered.
Q3
During claim preparation, the specialist notices that the referring provider's NPI is missing on a claim that requires it.
Submission without the NPI will most likely result in:
A. Processing without delay
B. Conversion to a secondary claim
C. Claim rejection or denial for missing required information
D. Automatic payment at a reduced rate
Correct Answer: C
Rationale:
Required data elements such as NPIs, when missing, cause the claim to be rejected or denied by the payer until corrected and resubmitted.
NHA CBCS Exam Questions and Verified Answers (2026/2027) 100% Guarantee Pass 2026/202... Page 2
, Q4
A claim is returned with a remark code indicating the patient's insurance was not in effect on the date of service. The
correct next action is to:
A. Ignore the denial and close the account
B. Verify coverage dates and either bill the correct payer or the patient
C. Resubmit the identical claim immediately
D. Write off the balance as contractual adjustment
Correct Answer: B
Rationale:
The specialist must confirm the actual coverage period and route the claim to the responsible party (correct insurance or patient) rather than
resubmitting an invalid claim.
Q5
When posting an explanation of benefits (EOB), the specialist sees that the allowed amount is lower than the billed
charge. The difference that cannot be billed to the patient under a contracted plan is a:
A. Contractual adjustment or write-off
B. Patient deductible
C. Copayment
D. Non-covered service charge
Correct Answer: A
Rationale:
Contractual adjustments represent the difference between billed charges and the payer's contracted allowed amount and are written off; they
are not patient responsibility.
Q6
A claim requires an attachment of medical records. The preferred modern method of sending supporting documentation
with an electronic claim is:
A. Faxing the records without a claim number
B. Mailing paper records only
C. Emailing unprotected PHI
D. Electronic claim attachment or payer portal upload
Correct Answer: D
Rationale:
Electronic attachments or secure portal uploads link documentation to the claim efficiently while protecting PHI, reducing delays compared
with paper mail.
Q7
The billing office receives a request for additional information from a payer 30 days after claim submission. The timely
response window is important because failure to respond can result in:
A. Extension of the timely filing deadline
B. Conversion to a clean claim status
C. Claim denial or closure for lack of requested information
D. Automatic approval of the original amount
Correct Answer: C
Rationale:
Payers set deadlines for additional documentation; missing the window typically leads to denial that may be difficult or impossible to overturn.
NHA CBCS Exam Questions and Verified Answers (2026/2027) 100% Guarantee Pass 2026/202... Page 3
NHA CBCS Exam Questions and Verified Answers
(2026/2027) 100% Guarantee Pass 2026/2027
A+
Complete Domain Coverage
A+ 5 100%
QUESTIONS VERIFIED CORE DOMAINS COVERED RATIONALES INCLUDED
CATEGORIES
1. Medical Billing Process and Claims Submission
2. Medical Coding Systems ICD-10-CM CPT and HCPCS
3. Insurance Plans Reimbursement and Payer Guidelines
4. Compliance HIPAA Fraud and Abuse Prevention
5. Revenue Cycle Management Patient Accounts and Collections
STUVIAACTUALEXAM
, SECTION 1: MEDICAL BILLING PROCESS AND CLAIMS SUBMISSION
Q1
A billing specialist is preparing a claim for an outpatient encounter. The claim form currently used for professional
services in the United States is the:
A. CMS-1500
B. UB-04
C. CMS-1450
D. ADA Dental Claim
Correct Answer: A
Rationale:
The CMS-1500 is the standard paper claim form for professional (physician) services. The UB-04 (CMS-1450) is used for institutional/facility
claims.
Q2
A patient presents a new insurance card at check-in. The specialist must verify eligibility before the visit to avoid claim
denials. The most reliable method is to:
A. Accept the card as presented without verification
B. Wait until the claim is submitted to discover issues
C. Ask the patient only whether coverage is active
D. Contact the payer via electronic eligibility inquiry or phone verification
Correct Answer: D
Rationale:
Real-time or batch electronic eligibility verification (or phone confirmation) confirms active coverage, benefits, and patient responsibility before
services are rendered.
Q3
During claim preparation, the specialist notices that the referring provider's NPI is missing on a claim that requires it.
Submission without the NPI will most likely result in:
A. Processing without delay
B. Conversion to a secondary claim
C. Claim rejection or denial for missing required information
D. Automatic payment at a reduced rate
Correct Answer: C
Rationale:
Required data elements such as NPIs, when missing, cause the claim to be rejected or denied by the payer until corrected and resubmitted.
NHA CBCS Exam Questions and Verified Answers (2026/2027) 100% Guarantee Pass 2026/202... Page 2
, Q4
A claim is returned with a remark code indicating the patient's insurance was not in effect on the date of service. The
correct next action is to:
A. Ignore the denial and close the account
B. Verify coverage dates and either bill the correct payer or the patient
C. Resubmit the identical claim immediately
D. Write off the balance as contractual adjustment
Correct Answer: B
Rationale:
The specialist must confirm the actual coverage period and route the claim to the responsible party (correct insurance or patient) rather than
resubmitting an invalid claim.
Q5
When posting an explanation of benefits (EOB), the specialist sees that the allowed amount is lower than the billed
charge. The difference that cannot be billed to the patient under a contracted plan is a:
A. Contractual adjustment or write-off
B. Patient deductible
C. Copayment
D. Non-covered service charge
Correct Answer: A
Rationale:
Contractual adjustments represent the difference between billed charges and the payer's contracted allowed amount and are written off; they
are not patient responsibility.
Q6
A claim requires an attachment of medical records. The preferred modern method of sending supporting documentation
with an electronic claim is:
A. Faxing the records without a claim number
B. Mailing paper records only
C. Emailing unprotected PHI
D. Electronic claim attachment or payer portal upload
Correct Answer: D
Rationale:
Electronic attachments or secure portal uploads link documentation to the claim efficiently while protecting PHI, reducing delays compared
with paper mail.
Q7
The billing office receives a request for additional information from a payer 30 days after claim submission. The timely
response window is important because failure to respond can result in:
A. Extension of the timely filing deadline
B. Conversion to a clean claim status
C. Claim denial or closure for lack of requested information
D. Automatic approval of the original amount
Correct Answer: C
Rationale:
Payers set deadlines for additional documentation; missing the window typically leads to denial that may be difficult or impossible to overturn.
NHA CBCS Exam Questions and Verified Answers (2026/2027) 100% Guarantee Pass 2026/202... Page 3
