NHA 2024-2025 CBCS
Which of the following is considered Protected Health Information (PHI) under the Health
Insurance Portability and Accountability Act (HIPPA)? - Answer- Patient's email address
Emily, a 45-year old patient, has recently been diagnosed with a chronic condition that requires
ongoing treatment. Her primary insurance is through her employer, but she also has a secondary
insurance through her spouse's employer. When submitting claims for Emily's treatment, what is
the correct order of billing to ensure proper coordination of benefits? - Answer- Submit the claim to
the primary insurance first, then the secondary insurance
Dr. Smith preformed a minor surgical procedure on John Doe at an outpatient surgery center.
Which place of service code should be used for this procedure? - Answer- 24- procedures
performed in an ambulatory surgery center ASC)
Sarah, a medical billing specialist, is reviewing the account of a patient named John Doe. She
notices that the insurance company has a lack of pre-authorization for a specific procedure. What
is the best course of action for Sarah to take to resolve this issue? - Answer- Obtain the necessary
pre-authorization and then resubmit the claim
Dr. Smith is submitting a CMS-1500 claim form for patient named John Doe, who received
outpatient services covered by medicare. Which section of the CMS-1500 form should Dr. Smith
complete to indicate the type of insurance plan covering John Doe?
- Box 1a- insured's ID Number
- Box 11- Insured Policy Group or FECA number
- Box 1- Insurance Type
- Box 24- Service Line Information - Answer- Box 1- Insurance Type
Which of the following is a primary purpose of internal audits in the context of medical billing and
coding? - Answer- To identify the correct coding errors before claim submissions
Dr. Smith's office received a request from John Does insurance company for his medical records
to process a claim. According to HIPPA regulations, what is the most appropriate action for Dr.
Smith's office to take? - Answer- Provide only the minimum necessary information required to
process the claim
When coding for Obstetrics, which of the following codes is used to indicate a routine prenatal visit
with no complications?
- Z34.00: Routine prenatal for normal first pregnancy no complications
- O09.89: Supervision of high risk pregnancy
- Z33.1: Encounter for pregnancy test
- O10.11: Pre-existing hypertension complicating pregnancy - Answer- Z34.00: Routine prenatal
for normal first pregnancy no complications
Sarah, a patient. has recently filled for bankruptcy. As a medical billing specialist, what is the
appropriate action to take regarding her outstanding medical bills? - Answer- Cease all collection
activities and notify the bankruptcy court
, When coding for telemedicine services, which modifier should be appended to indicate the service
was provided via Telehealth? - Answer- Modifier 95
When a patient has multiple insurance plans, which insurance plan is typically considered the
primary insurance? - Answer- The insurance plan provided by the patients employer
Sarah, a medical billing specialist, is verifying insurance eligibility for a patient named John who
has a commercial insurance plan. Which of the following is a requirement she must fulfill to ensure
that John's insurance eligibility is verified correctly? - Answer- Confirm the patient's policy number
and group number
Which of the following is the most crucial step in ensuring all applicable charges are captured for
optimal reimbursement? - Answer- Reviewing patient encounter forms and progress notes
Sarah, a patient with a PPO insurance plan, needs to undergo a specialized surgery. Her
preferred surgeon is out-of-network. Which of the following steps should Sarah take to understand
her out-of-network coverage and potential costs? - Answer- Contact her insurance company to
verify out-of-network benefits and obtain pre-authorization
What is the first step in the insurance eligibility and benefits verification process? - Answer-
Verifying a patient's insurance coverage
Sarah visits her primary care physician for a routine check-up. Her insurance plan has 20%
coinsurance rate after meeting a $200 deductible. The total bill for the visit is $500 , and Sarah has
already met her deductible for the year.How much is Sarah responsible for paying out-of-pocket
for this visit?
- $100
- $200
- $300
- $400 - Answer- $100
When coding for a total knee arthroplasty in an orthopedic speciality, which of the following CPT
codes is the most appropriate? - Answer- 27447
What is the primary purpose of a deductible in a health insurance policy? - Answer- To ensure the
patient shares in the cost of their healthcare services
Which of the following government insurance plans primarily covers individuals aged 65 and older,
as well as certain individuals with disabilities? - Answer- Medicare
Mr. Johnson, a 68-year old patient, is enrolled in Medicare. He needs a comprehensive
understanding of his coverage options. Which part of Medicare will cover his inpatient hospital stay
if he is admitted for a surgical procedure? - Answer- Medicare Part A
Dr. Smith performed a laparoscopic cholecystectomy on a 45-year old patient named John Doe.
The procedure was uncomplicated, and the patient was discharged the same day. Which CPT
code should be used to accurately represent the procedure? - Answer- 47562: Uncomplicated
laparoscopic cholecystectomy
Which of the following is considered Protected Health Information (PHI) under the Health
Insurance Portability and Accountability Act (HIPPA)? - Answer- Patient's email address
Emily, a 45-year old patient, has recently been diagnosed with a chronic condition that requires
ongoing treatment. Her primary insurance is through her employer, but she also has a secondary
insurance through her spouse's employer. When submitting claims for Emily's treatment, what is
the correct order of billing to ensure proper coordination of benefits? - Answer- Submit the claim to
the primary insurance first, then the secondary insurance
Dr. Smith preformed a minor surgical procedure on John Doe at an outpatient surgery center.
Which place of service code should be used for this procedure? - Answer- 24- procedures
performed in an ambulatory surgery center ASC)
Sarah, a medical billing specialist, is reviewing the account of a patient named John Doe. She
notices that the insurance company has a lack of pre-authorization for a specific procedure. What
is the best course of action for Sarah to take to resolve this issue? - Answer- Obtain the necessary
pre-authorization and then resubmit the claim
Dr. Smith is submitting a CMS-1500 claim form for patient named John Doe, who received
outpatient services covered by medicare. Which section of the CMS-1500 form should Dr. Smith
complete to indicate the type of insurance plan covering John Doe?
- Box 1a- insured's ID Number
- Box 11- Insured Policy Group or FECA number
- Box 1- Insurance Type
- Box 24- Service Line Information - Answer- Box 1- Insurance Type
Which of the following is a primary purpose of internal audits in the context of medical billing and
coding? - Answer- To identify the correct coding errors before claim submissions
Dr. Smith's office received a request from John Does insurance company for his medical records
to process a claim. According to HIPPA regulations, what is the most appropriate action for Dr.
Smith's office to take? - Answer- Provide only the minimum necessary information required to
process the claim
When coding for Obstetrics, which of the following codes is used to indicate a routine prenatal visit
with no complications?
- Z34.00: Routine prenatal for normal first pregnancy no complications
- O09.89: Supervision of high risk pregnancy
- Z33.1: Encounter for pregnancy test
- O10.11: Pre-existing hypertension complicating pregnancy - Answer- Z34.00: Routine prenatal
for normal first pregnancy no complications
Sarah, a patient. has recently filled for bankruptcy. As a medical billing specialist, what is the
appropriate action to take regarding her outstanding medical bills? - Answer- Cease all collection
activities and notify the bankruptcy court
, When coding for telemedicine services, which modifier should be appended to indicate the service
was provided via Telehealth? - Answer- Modifier 95
When a patient has multiple insurance plans, which insurance plan is typically considered the
primary insurance? - Answer- The insurance plan provided by the patients employer
Sarah, a medical billing specialist, is verifying insurance eligibility for a patient named John who
has a commercial insurance plan. Which of the following is a requirement she must fulfill to ensure
that John's insurance eligibility is verified correctly? - Answer- Confirm the patient's policy number
and group number
Which of the following is the most crucial step in ensuring all applicable charges are captured for
optimal reimbursement? - Answer- Reviewing patient encounter forms and progress notes
Sarah, a patient with a PPO insurance plan, needs to undergo a specialized surgery. Her
preferred surgeon is out-of-network. Which of the following steps should Sarah take to understand
her out-of-network coverage and potential costs? - Answer- Contact her insurance company to
verify out-of-network benefits and obtain pre-authorization
What is the first step in the insurance eligibility and benefits verification process? - Answer-
Verifying a patient's insurance coverage
Sarah visits her primary care physician for a routine check-up. Her insurance plan has 20%
coinsurance rate after meeting a $200 deductible. The total bill for the visit is $500 , and Sarah has
already met her deductible for the year.How much is Sarah responsible for paying out-of-pocket
for this visit?
- $100
- $200
- $300
- $400 - Answer- $100
When coding for a total knee arthroplasty in an orthopedic speciality, which of the following CPT
codes is the most appropriate? - Answer- 27447
What is the primary purpose of a deductible in a health insurance policy? - Answer- To ensure the
patient shares in the cost of their healthcare services
Which of the following government insurance plans primarily covers individuals aged 65 and older,
as well as certain individuals with disabilities? - Answer- Medicare
Mr. Johnson, a 68-year old patient, is enrolled in Medicare. He needs a comprehensive
understanding of his coverage options. Which part of Medicare will cover his inpatient hospital stay
if he is admitted for a surgical procedure? - Answer- Medicare Part A
Dr. Smith performed a laparoscopic cholecystectomy on a 45-year old patient named John Doe.
The procedure was uncomplicated, and the patient was discharged the same day. Which CPT
code should be used to accurately represent the procedure? - Answer- 47562: Uncomplicated
laparoscopic cholecystectomy
