NHA - Certified Billing and Coding Specialist (CBCS)
Study Guide
1. The symbol "O" in the Current Procedural Terminology reference is
used to indicate what?: Reinstated or recycled code
2. In the anesthesia section of the CPT manual, what are considered
qualify- ing circumstances?: Add-on codes
3. As of April 1, 2014 what is the maximum number of diagnoses that can
be reported on the CMS-1500 claim form before a further claim is
required?: 12
4. What is considered proper supportive documentation for reporting CPT
and ICD codes for surgical procedures?: Operative report
5. What action should be taken first when reviewing a delinquent claim?:
Ver- ify the age of the account
6. A claim can be denied or rejected for which of the following reasons?: -
Block 24D contains the diagnosis code
7. A coroner's autopsy is comprised of what examinations?: Gross
,Examina- tion
8. Medigap coverage is offered to Medicare beneficiaries by whom?:
Private third-party payers
9. What part of Medicare covers prescriptions?: Part C
10.What plane divides the body into left and right?: Sagittal
11.Where can unlisted codes be found in the CPT manual?: Guidelines
prior to each section
12.Ambulatory surgery centers, home health care, and hospice
organiza- tions use which form to submit claims?: UB-04 Claim Form
13.What color format is acceptable on the CMS-1500 claim form?: Red
14.Who is responsible to pay the deductible?: Patient
15.A patient's health plan is referred to as the "payer of last resort." What
is the name of that health plan?: Medicaid
16.Informed Consent: Providers explain medical or diagnostic
procedures, surgi- cal interventions, and the benefits and risks
involved, giving patients an opportunity to ask questions before
medical intervention is provided.
17.Implied Consent: A patient presents for treatment, such as
extending an arm to allow a venipuncture to be performed.
, 18.Clearinghouse: Agency that converts claims into standardized
electronic for- mat, looks for errors, and formats them according to
HIPAA and insurance stan- dards.
19.Individually Identifiable: Documents that identify the person or
provide enough information so that the person can be identified.
20.De-identified Information: Information that does not identify an
individual because unique and personal characteristics have been
removed.
21.Consent: A patient's permission evidenced by signature.
22.Authorizations: Permission granted by the patient or the patient's
represen- tative to release information for reasons other than
treatment, payment, or health care operations.
23.Reimbursement: Payment for services rendered from a third-party
payer.
24.Auditing: Review of claims for accuracy and completeness.
25.Fraud: Making false statements of representations of material facts
to obtain some benefit or payment for which no entitlement would
otherwise exist.
26.Upcoding: Assigning a diagnosis or procedure code at a higher level
than the documentation supports, such as coding bronchitis as
pneumonia.
27.Unbundling: Using multiple codes that describe different
components of a treatment instead of using a single code that
Study Guide
1. The symbol "O" in the Current Procedural Terminology reference is
used to indicate what?: Reinstated or recycled code
2. In the anesthesia section of the CPT manual, what are considered
qualify- ing circumstances?: Add-on codes
3. As of April 1, 2014 what is the maximum number of diagnoses that can
be reported on the CMS-1500 claim form before a further claim is
required?: 12
4. What is considered proper supportive documentation for reporting CPT
and ICD codes for surgical procedures?: Operative report
5. What action should be taken first when reviewing a delinquent claim?:
Ver- ify the age of the account
6. A claim can be denied or rejected for which of the following reasons?: -
Block 24D contains the diagnosis code
7. A coroner's autopsy is comprised of what examinations?: Gross
,Examina- tion
8. Medigap coverage is offered to Medicare beneficiaries by whom?:
Private third-party payers
9. What part of Medicare covers prescriptions?: Part C
10.What plane divides the body into left and right?: Sagittal
11.Where can unlisted codes be found in the CPT manual?: Guidelines
prior to each section
12.Ambulatory surgery centers, home health care, and hospice
organiza- tions use which form to submit claims?: UB-04 Claim Form
13.What color format is acceptable on the CMS-1500 claim form?: Red
14.Who is responsible to pay the deductible?: Patient
15.A patient's health plan is referred to as the "payer of last resort." What
is the name of that health plan?: Medicaid
16.Informed Consent: Providers explain medical or diagnostic
procedures, surgi- cal interventions, and the benefits and risks
involved, giving patients an opportunity to ask questions before
medical intervention is provided.
17.Implied Consent: A patient presents for treatment, such as
extending an arm to allow a venipuncture to be performed.
, 18.Clearinghouse: Agency that converts claims into standardized
electronic for- mat, looks for errors, and formats them according to
HIPAA and insurance stan- dards.
19.Individually Identifiable: Documents that identify the person or
provide enough information so that the person can be identified.
20.De-identified Information: Information that does not identify an
individual because unique and personal characteristics have been
removed.
21.Consent: A patient's permission evidenced by signature.
22.Authorizations: Permission granted by the patient or the patient's
represen- tative to release information for reasons other than
treatment, payment, or health care operations.
23.Reimbursement: Payment for services rendered from a third-party
payer.
24.Auditing: Review of claims for accuracy and completeness.
25.Fraud: Making false statements of representations of material facts
to obtain some benefit or payment for which no entitlement would
otherwise exist.
26.Upcoding: Assigning a diagnosis or procedure code at a higher level
than the documentation supports, such as coding bronchitis as
pneumonia.
27.Unbundling: Using multiple codes that describe different
components of a treatment instead of using a single code that
