NHA CBCS Study Guide
Medicare Part A - Answer -Covers home health care, skilled services, and hospice care for terminally ill
patients.
Medicare Part B - Answer -Covers outpatient hospital services and home health services not covered by
Part A.
Medicare Part C - Answer -Covers Medicare Advantage Plans.
Medicare Part D - Answer -Covers the cost of prescriptions.
The remittance advice will include a claims adjustment reason code for any reimbursements that are
denied or are different from the usual reimbursement. - Answer -Claims adjustment reason code
An unlisted code is a CPT procedure code that is used for unusual procedures that have no listed codes. -
Answer -Unlisted Code
A taxonomy code is used to identify specialty training for providers. - Answer -Taxonomy code
Fee-for-service is a method of payment in which the patient pays the provider for each service from a
schedule of fees. - Answer -Fee-for-Service
, A guarantor is the patient or another authorized party responsible for the patient's health bill. - Answer -
Guarantor
An insurance company. that offers plans that pay health care providers who render services to patients
is a third-party payer. - Answer -Third Party Payer
Abusive Billing Pattern - Answer -Which of the following describes the practice of routinely submitting
claims that have the same coding or modifier errors?
A clearinghouse is an organization that receives claims from providers, scans them for technical errors,
formats them for the various third-party payers, and submits them on behalf of the provider. - Answer -
Clearinghouse
A billing and coding specialist notices that a provider is reporting the same code for all new patient visits
to get higher reimbursements. The specialist should identify this as which of the following? - Answer -
Fraud
During which of the following steps of the revenue cycle does effective communication begin? - Answer
-Registration and Scheduling
Which of the following is a claim that is possible to adjudicate and includes all required data elements? -
Answer -Clean Claim
A billing and coding specialist should identify that the Office of Inspector General (OIG) has which of the
following roles? - Answer -To identify Medicare fraud and abuse
A billing and coding specialist should identify that a Medicare Recovery Audit Contractor (RAC) can
review medical records for which of the following reasons? - Answer -To investigate potential improper
Medicare payments
Which of the following is an effective tool for collecting a patient's payment for health care service? -
Answer -Communication
Medicare Part A - Answer -Covers home health care, skilled services, and hospice care for terminally ill
patients.
Medicare Part B - Answer -Covers outpatient hospital services and home health services not covered by
Part A.
Medicare Part C - Answer -Covers Medicare Advantage Plans.
Medicare Part D - Answer -Covers the cost of prescriptions.
The remittance advice will include a claims adjustment reason code for any reimbursements that are
denied or are different from the usual reimbursement. - Answer -Claims adjustment reason code
An unlisted code is a CPT procedure code that is used for unusual procedures that have no listed codes. -
Answer -Unlisted Code
A taxonomy code is used to identify specialty training for providers. - Answer -Taxonomy code
Fee-for-service is a method of payment in which the patient pays the provider for each service from a
schedule of fees. - Answer -Fee-for-Service
, A guarantor is the patient or another authorized party responsible for the patient's health bill. - Answer -
Guarantor
An insurance company. that offers plans that pay health care providers who render services to patients
is a third-party payer. - Answer -Third Party Payer
Abusive Billing Pattern - Answer -Which of the following describes the practice of routinely submitting
claims that have the same coding or modifier errors?
A clearinghouse is an organization that receives claims from providers, scans them for technical errors,
formats them for the various third-party payers, and submits them on behalf of the provider. - Answer -
Clearinghouse
A billing and coding specialist notices that a provider is reporting the same code for all new patient visits
to get higher reimbursements. The specialist should identify this as which of the following? - Answer -
Fraud
During which of the following steps of the revenue cycle does effective communication begin? - Answer
-Registration and Scheduling
Which of the following is a claim that is possible to adjudicate and includes all required data elements? -
Answer -Clean Claim
A billing and coding specialist should identify that the Office of Inspector General (OIG) has which of the
following roles? - Answer -To identify Medicare fraud and abuse
A billing and coding specialist should identify that a Medicare Recovery Audit Contractor (RAC) can
review medical records for which of the following reasons? - Answer -To investigate potential improper
Medicare payments
Which of the following is an effective tool for collecting a patient's payment for health care service? -
Answer -Communication
