NHA CBCS EXAM REVIEW l Fully solved 2023

Which of the following Medicare policies determines if a particular item or service is covered by Medicare? - CORRECT ANSWER National Coverage Determination (NCD) A patient's employer has not submitted a premium payment. Which of the following claim statuses should the provider receive from the third-party payer? - CORRECT ANSWER Denied A billing and coding specialist should routinely analyze which of the following to determine the number of outstanding claims? - CORRECT ANSWER Aging report Which of the following should a billing and coding specialist use to submit a claim with supporting documents? - CORRECT ANSWER Claims attachment Which of the following terms is used to communicate why a claim line item was denied or paid differently than it was billing? - CORRECT ANSWER Claim adjustment codes On a CMS-1500 claim form, which of the following information should the billing and coding specialist enter into Block 32? - CORRECT ANSWER Service facility location information A provider's office receives a subpoena requesting medical documentation from a patient's medical record. After confirming the correct authorization, which of the following actions should the billing and coding specialist take? - CORRECT ANSWER Send the medical information pertaining to the dates of service requested Which of the following is the deadline for Medicare claim submission? - CORRECT ANSWER 12 months from the date of service Which of the following forms does a third-party payer require for physician services? - CORRECT ANSWER CMS-1500 A patient who is an active member of the military recently returned from overseas and is in need of specialty care. The patient does not have anyone designed with power of attorney. Which of the following is considered a HIPAA violation? - CORRECT ANSWER The billing and coding specialist sends the patient's records to the patient's partner. Which of the following terms refers to the difference between the billing and allowed amounts? - CORRECT ANSWER Adjustment Which of the following HMO managed care services requires a referral? - CORRECT ANSWER Durable medical equipment Which of the following explains why Medicare will deny a particular service or procedure? - CORRECT ANSWER Advance Beneficiary Notice (ABN) Which of the following types of claims is 120 days old? - CORRECT ANSWER Delinquent When reviewing an established patient's insurance card, the billing and coding specialist notices a minor change from the existing card on file. Which of the following actions should the billing and coding specialist take? - CORRECT ANSWER Photocopy both sides of the new card A husband and wife each have group insurance through their employers. The wife has an appointment with her provider. Which insurance should be used as primary for the appointment? - CORRECT ANSWER The wife's insurance Which of the following would most likely result in a denial on a Medicare claim? - CORRECT ANSWER An experimental chemotherapy medication for a patient who has stage III renal cancer