NHA Certified Billing and Coding Specialist
(CBCS)
Test Plan for the CBCS Exam
100 Scored Items/25 Pretest Items
Exam Time: 3 hours
*Based on The Results of a Job Analysis Completed in 2020
This document provides both a summary and detailed outline of the topics that may be covered on
the CBCS Certification Examination. The summary examination outline specifies domains that
are covered on the examination and the number of test items per domain.
The detailed outline adds to the summary outline by including task and knowledge
statements associated with each domain on the test plan. Task statements reflect the duties that
a candidate will need to know how to properly perform. Knowledge statements reflect information
that a candidate will need to know and are in support of task statements. Items on the
examination might require recall and critical thinking pertaining to a knowledge statement, a
task statement, or both.
CBCS Summary Examination Outline
# of Items on
DOMAIN Examination
1. The Revenue Cycle and Regulatory Compliance 15
2. Insurance Eligibility and Other Payer Requirements 20
3. Coding and Coding Guidelines 32
4. Billing and Reimbursement 33
Total 100
, CBCS Detailed Examination Outline
Domain 1: The Revenue Cycle and Regulatory Compliance (15 items)
Tasks Knowledge of:
1A Integrate revenue cycle concepts with k1. The phases of the revenue cycle and how they
knowledge of business and payer interact/impact each other
requirements to support accurate coding
k2. Laws, regulations, and administrative agency requirements
and timely reimbursement.
relevant to billing and coding roles (e.g., HIPAA, Health
1B Clearly and accurately communicate with Information Technology for Economic and Clinical Health Act
stakeholders (e.g., providers, patients, [HITECH Act], Fair Debt Collection Practices Act, False
payers) throughout all phases of the Claims Act, Stark Law)
revenue cycle.
k3. Types of data considered PHI (e.g., email addresses, next of
1C Maintain confidentiality and security of kin, phone numbers, Social Security numbers)
protected health information (PHI).
k4. Permitted use and disclosure of patient information (including
1D Release PHI when required in accordance proper documentation, Health and Human Services
with the Health Insurance Portability and [HHS]/Centers for Medicare & Medicaid Services [CMS] use
Accountability Act (HIPAA) and facility of data)
policy.
k5. The role of the Office of the Inspector General (OIG) in
1E Ensure compliance with federal laws, medical billing
regulations, and guidelines and help
k6. Components of a compliance plan and the application of the
prevent fraud and abuse by adhering to
Provider Self-Disclosure Protocol (SDP)
billing policies, coding rules, and
conventions to submit clean and accurate k7. Indicators of potential billing fraud and abuse
claims.
k8. Informed, written, and implied consent
k9. Internal and third-party auditing requirements (e.g., Medicare
Recovery Audit Contractor (RAC), Zone Program Integrity
Contractor (ZPIC), payer-focused)
Detailed Test Plan based on the 2020 Practice Analysis Study
(CBCS)
Test Plan for the CBCS Exam
100 Scored Items/25 Pretest Items
Exam Time: 3 hours
*Based on The Results of a Job Analysis Completed in 2020
This document provides both a summary and detailed outline of the topics that may be covered on
the CBCS Certification Examination. The summary examination outline specifies domains that
are covered on the examination and the number of test items per domain.
The detailed outline adds to the summary outline by including task and knowledge
statements associated with each domain on the test plan. Task statements reflect the duties that
a candidate will need to know how to properly perform. Knowledge statements reflect information
that a candidate will need to know and are in support of task statements. Items on the
examination might require recall and critical thinking pertaining to a knowledge statement, a
task statement, or both.
CBCS Summary Examination Outline
# of Items on
DOMAIN Examination
1. The Revenue Cycle and Regulatory Compliance 15
2. Insurance Eligibility and Other Payer Requirements 20
3. Coding and Coding Guidelines 32
4. Billing and Reimbursement 33
Total 100
, CBCS Detailed Examination Outline
Domain 1: The Revenue Cycle and Regulatory Compliance (15 items)
Tasks Knowledge of:
1A Integrate revenue cycle concepts with k1. The phases of the revenue cycle and how they
knowledge of business and payer interact/impact each other
requirements to support accurate coding
k2. Laws, regulations, and administrative agency requirements
and timely reimbursement.
relevant to billing and coding roles (e.g., HIPAA, Health
1B Clearly and accurately communicate with Information Technology for Economic and Clinical Health Act
stakeholders (e.g., providers, patients, [HITECH Act], Fair Debt Collection Practices Act, False
payers) throughout all phases of the Claims Act, Stark Law)
revenue cycle.
k3. Types of data considered PHI (e.g., email addresses, next of
1C Maintain confidentiality and security of kin, phone numbers, Social Security numbers)
protected health information (PHI).
k4. Permitted use and disclosure of patient information (including
1D Release PHI when required in accordance proper documentation, Health and Human Services
with the Health Insurance Portability and [HHS]/Centers for Medicare & Medicaid Services [CMS] use
Accountability Act (HIPAA) and facility of data)
policy.
k5. The role of the Office of the Inspector General (OIG) in
1E Ensure compliance with federal laws, medical billing
regulations, and guidelines and help
k6. Components of a compliance plan and the application of the
prevent fraud and abuse by adhering to
Provider Self-Disclosure Protocol (SDP)
billing policies, coding rules, and
conventions to submit clean and accurate k7. Indicators of potential billing fraud and abuse
claims.
k8. Informed, written, and implied consent
k9. Internal and third-party auditing requirements (e.g., Medicare
Recovery Audit Contractor (RAC), Zone Program Integrity
Contractor (ZPIC), payer-focused)
Detailed Test Plan based on the 2020 Practice Analysis Study
