NHA CBCS CERTIFICATION
Which of the following is considered the final determination of the issues involving
settlement of an insurance claim? - ANSWER Adjudication
A form that contains charges, DOS, CPT codes, ICD codes, fees and copayment
information is called which of the following? - ANSWER Encounter form
A patient comes to the hospital for an inpatient procedure. Which of the following
hospital staff members is responsible for the initial patient interview, obtaining
demographic and insurance information, and documenting the chief complaint? -
ANSWER Admitting clerk
Which of the following privacy measures ensures protected health information (phi)?
- ANSWER Using data encryption software on office workstations
Which of the following planes divides the body into left and right? - ANSWER Sagittal
Which of the following provisions ensures that an insured's benefits from all
insurance companies do not exceed 100% of allowable medical expenses? -
ANSWER Coordination of benefits
Which of the following actions should be taken first when reviewing a delinquent
claim? - ANSWER Verify the age of the account
Which of the following is the advantage of electronic claim submission? - ANSWER
Claims are expedited
Which of the following components of an explanation of benefits expedites the
process of a phone appeal? - ANSWER Claim control number
The standard medical abbreviation ECG refers to a test used to assess which of the
following body systems? - ANSWER Cardiovascular system
Which of the following actions by a billing and coding specialist would be considered
fraud? - ANSWER Billing for services not provided
The >< symbol is used to indicate a new and revised test other than which of the
following? - ANSWER Procedure descriptors
On the CMS-1500 claim form, blocks 14 through 33 contain information about which
of the following? - ANSWER The patient's condition and the provider's information
Which of the following includes procedures and best practices for correct coding? -
ANSWER Coding Compliance Plan
, When completing a CMS-1500 paper claim form, which of the following is an
acceptable action for the billing and coding specialist to take? - ANSWER Use arial
size 10 font
A participating blue cross/blue shield (BC/BS) provider receives an explanation of
benefits for a patient account. The charged amount was $100. BC/BS allowed $80
and applied $40 to the patient's annual deductible. BC/BS paid the balance at 80%.
How much should the patient expect to pay? - ANSWER $48
Which of the following indicates a claim should be submitted on paper instead of
electronically? - ANSWER The claim requires an attachment
According to HIPAA standards, which of the following identifies the rendering
provider on the CMS-1500 claim form in block 24j? - ANSWER NPI
Which of the following blocks should the billing and coding specialist complete on the
CMS-1500 claim form form for procedures, services or supplies (CPT/HCPCS)? -
ANSWER Block 24D
Which of the following terms describes when a plan pays 70% of the allowed amount
and the patient pays 30%? - ANSWER Coinsurance
A provider charged $500 to claim that had an allowable amount of $400. In which of
the following columns should the billing and coding specialist apply the non-allowed
charge? - ANSWER Adjustment column of the credits
Which of the following is a HIPAA compliance guideline affecting electronic health
records? - ANSWER The electronic transmission and code set standards require
every provider to use the healthcare transactions ,code sets and identifiers
Patient: Jane Austin; Social Security # 555-22-1111; Medicare ID: 555-33-2222A;
DOB: 05/22/1945. Claim information entered: Austin, Jane; Social Security #.: 555-
22-1111; Medicare ID No.: 555-33-2222A; DOB: 052245. Which of the following is a
reason this claim was rejected? - ANSWER The DOB is entered incorrectly
Why does correct claim processing rely on accurately completed encounter forms? -
ANSWER They streamline patient billing by summarizing the services rendered for a
given date of service
A patient's health plan is referred to as the "payer of last resort." The patient is
covered by which of the following health plans? - ANSWER Medicaid
Which of the following color formats is acceptable on the CMS-1500 claim form? -
ANSWER Red
Which of the following is an example of a violation of an adult patient's
confidentiality? - ANSWER Patient information was disclosed to the patient's parents
without consent.
Which of the following is considered the final determination of the issues involving
settlement of an insurance claim? - ANSWER Adjudication
A form that contains charges, DOS, CPT codes, ICD codes, fees and copayment
information is called which of the following? - ANSWER Encounter form
A patient comes to the hospital for an inpatient procedure. Which of the following
hospital staff members is responsible for the initial patient interview, obtaining
demographic and insurance information, and documenting the chief complaint? -
ANSWER Admitting clerk
Which of the following privacy measures ensures protected health information (phi)?
- ANSWER Using data encryption software on office workstations
Which of the following planes divides the body into left and right? - ANSWER Sagittal
Which of the following provisions ensures that an insured's benefits from all
insurance companies do not exceed 100% of allowable medical expenses? -
ANSWER Coordination of benefits
Which of the following actions should be taken first when reviewing a delinquent
claim? - ANSWER Verify the age of the account
Which of the following is the advantage of electronic claim submission? - ANSWER
Claims are expedited
Which of the following components of an explanation of benefits expedites the
process of a phone appeal? - ANSWER Claim control number
The standard medical abbreviation ECG refers to a test used to assess which of the
following body systems? - ANSWER Cardiovascular system
Which of the following actions by a billing and coding specialist would be considered
fraud? - ANSWER Billing for services not provided
The >< symbol is used to indicate a new and revised test other than which of the
following? - ANSWER Procedure descriptors
On the CMS-1500 claim form, blocks 14 through 33 contain information about which
of the following? - ANSWER The patient's condition and the provider's information
Which of the following includes procedures and best practices for correct coding? -
ANSWER Coding Compliance Plan
, When completing a CMS-1500 paper claim form, which of the following is an
acceptable action for the billing and coding specialist to take? - ANSWER Use arial
size 10 font
A participating blue cross/blue shield (BC/BS) provider receives an explanation of
benefits for a patient account. The charged amount was $100. BC/BS allowed $80
and applied $40 to the patient's annual deductible. BC/BS paid the balance at 80%.
How much should the patient expect to pay? - ANSWER $48
Which of the following indicates a claim should be submitted on paper instead of
electronically? - ANSWER The claim requires an attachment
According to HIPAA standards, which of the following identifies the rendering
provider on the CMS-1500 claim form in block 24j? - ANSWER NPI
Which of the following blocks should the billing and coding specialist complete on the
CMS-1500 claim form form for procedures, services or supplies (CPT/HCPCS)? -
ANSWER Block 24D
Which of the following terms describes when a plan pays 70% of the allowed amount
and the patient pays 30%? - ANSWER Coinsurance
A provider charged $500 to claim that had an allowable amount of $400. In which of
the following columns should the billing and coding specialist apply the non-allowed
charge? - ANSWER Adjustment column of the credits
Which of the following is a HIPAA compliance guideline affecting electronic health
records? - ANSWER The electronic transmission and code set standards require
every provider to use the healthcare transactions ,code sets and identifiers
Patient: Jane Austin; Social Security # 555-22-1111; Medicare ID: 555-33-2222A;
DOB: 05/22/1945. Claim information entered: Austin, Jane; Social Security #.: 555-
22-1111; Medicare ID No.: 555-33-2222A; DOB: 052245. Which of the following is a
reason this claim was rejected? - ANSWER The DOB is entered incorrectly
Why does correct claim processing rely on accurately completed encounter forms? -
ANSWER They streamline patient billing by summarizing the services rendered for a
given date of service
A patient's health plan is referred to as the "payer of last resort." The patient is
covered by which of the following health plans? - ANSWER Medicaid
Which of the following color formats is acceptable on the CMS-1500 claim form? -
ANSWER Red
Which of the following is an example of a violation of an adult patient's
confidentiality? - ANSWER Patient information was disclosed to the patient's parents
without consent.
