NHA - Certified Billing and Coding Specialist
(CBCS)
What does the symbol 'O' in the Current Procedural Terminology reference indicate? - Answer-
Reinstated or recycled code
What are considered qualifying circumstances in the anesthesia section of the CPT manual? -
Answer- Add-on codes
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? - Answer- 12
What is considered proper supportive documentation for reporting CPT and ICD codes for surgical
procedures? - Answer- Operative report
What is the first action to take when reviewing a delinquent claim? - Answer- Verify the age of the
account
For which of the following reasons can a claim be denied or rejected? - Answer- Block 24D
contains the diagnosis code
What examinations are comprised in a coroner's autopsy? - Answer- Gross Examination
Who offers Medigap coverage to Medicare beneficiaries? - Answer- Private third-party payers
Which part of Medicare covers prescriptions? - Answer- Part D
Which plane divides the body into left and right? - Answer- Sagittal
Where are unlisted codes located in the CPT manual? - Answer- Guidelines prior to each section
What form do ambulatory surgery centers, home health care, and hospice organizations use to
submit claims? - Answer- UB-04 Claim Form
What color format is accepted on the CMS-1500 claim form? - Answer- Red
Who is responsible for paying the deductible? - Answer- Patient
What is the patient's health plan referred to as the 'payer of last resort'? - Answer- Medicaid
Definition: Informed Consent - Answer- Providers explain medical procedures, surgical
interventions, benefits, and risks to patients before intervention.
Definition: Implied Consent - Answer- Patient's actions imply consent for treatment, e.g., extending
an arm for venipuncture.
, What is the role of a Clearinghouse in medical billing? - Answer- Converts claims to electronic
format, checks for errors, and ensures compliance with HIPAA and insurance standards.
What does 'Individually Identifiable' mean in healthcare documentation? - Answer- Information that
can identify a person or provide enough details for identification.
What is 'De-identified Information' in healthcare? - Answer- Information with personal
characteristics removed, making it unable to identify an individual.
Consent - Answer- A patient's permission evidenced by signature.
Authorizations - Answer- Permission granted by the patient or the patient's representative for
purposes other than treatment, payment, or health care operations.
Reimbursement - Answer- Payment for services provided by a third-party payer.
Auditing - Answer- Reviewing claims for accuracy and completeness.
Fraud - Answer- Making false statements to obtain undeserved benefits or payments.
Upcoding - Answer- Assigning a higher-level code than supported by documentation, like coding
bronchitis as pneumonia.
Unbundling - Answer- Using multiple codes for separate treatment components instead of a single
comprehensive code.
Abuse - Answer- Practices leading to unnecessary costs for Medicare.
Business Associate (BA) - Answer- Individuals or organizations outside a covered entity's
workforce performing functions for the entity.
Main Role of the Office of the Inspector General (OIG) - Answer- Protecting Medicare and HHS
programs from fraud and abuse through audits, investigations, and inspections.
Medicare - Answer- Federally funded health insurance for individuals aged 65 or older, and
younger individuals with certain disabilities.
Medicaid - Answer- Government-based health insurance program for individuals with low incomes
and limited financial resources.
Timely Filing Requirements - Answer- Claims must be submitted within 1 calendar year of the date
of service.
Electronic Data Interchange (EDI) - Answer- Standardized electronic transfer of information.
Coordination of Benefits Rules - Answer- Rules that determine primary and secondary insurance
coverage.
Conditional Payment - Answer- Medicare payment recovered after primary insurance pays.
(CBCS)
What does the symbol 'O' in the Current Procedural Terminology reference indicate? - Answer-
Reinstated or recycled code
What are considered qualifying circumstances in the anesthesia section of the CPT manual? -
Answer- Add-on codes
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? - Answer- 12
What is considered proper supportive documentation for reporting CPT and ICD codes for surgical
procedures? - Answer- Operative report
What is the first action to take when reviewing a delinquent claim? - Answer- Verify the age of the
account
For which of the following reasons can a claim be denied or rejected? - Answer- Block 24D
contains the diagnosis code
What examinations are comprised in a coroner's autopsy? - Answer- Gross Examination
Who offers Medigap coverage to Medicare beneficiaries? - Answer- Private third-party payers
Which part of Medicare covers prescriptions? - Answer- Part D
Which plane divides the body into left and right? - Answer- Sagittal
Where are unlisted codes located in the CPT manual? - Answer- Guidelines prior to each section
What form do ambulatory surgery centers, home health care, and hospice organizations use to
submit claims? - Answer- UB-04 Claim Form
What color format is accepted on the CMS-1500 claim form? - Answer- Red
Who is responsible for paying the deductible? - Answer- Patient
What is the patient's health plan referred to as the 'payer of last resort'? - Answer- Medicaid
Definition: Informed Consent - Answer- Providers explain medical procedures, surgical
interventions, benefits, and risks to patients before intervention.
Definition: Implied Consent - Answer- Patient's actions imply consent for treatment, e.g., extending
an arm for venipuncture.
, What is the role of a Clearinghouse in medical billing? - Answer- Converts claims to electronic
format, checks for errors, and ensures compliance with HIPAA and insurance standards.
What does 'Individually Identifiable' mean in healthcare documentation? - Answer- Information that
can identify a person or provide enough details for identification.
What is 'De-identified Information' in healthcare? - Answer- Information with personal
characteristics removed, making it unable to identify an individual.
Consent - Answer- A patient's permission evidenced by signature.
Authorizations - Answer- Permission granted by the patient or the patient's representative for
purposes other than treatment, payment, or health care operations.
Reimbursement - Answer- Payment for services provided by a third-party payer.
Auditing - Answer- Reviewing claims for accuracy and completeness.
Fraud - Answer- Making false statements to obtain undeserved benefits or payments.
Upcoding - Answer- Assigning a higher-level code than supported by documentation, like coding
bronchitis as pneumonia.
Unbundling - Answer- Using multiple codes for separate treatment components instead of a single
comprehensive code.
Abuse - Answer- Practices leading to unnecessary costs for Medicare.
Business Associate (BA) - Answer- Individuals or organizations outside a covered entity's
workforce performing functions for the entity.
Main Role of the Office of the Inspector General (OIG) - Answer- Protecting Medicare and HHS
programs from fraud and abuse through audits, investigations, and inspections.
Medicare - Answer- Federally funded health insurance for individuals aged 65 or older, and
younger individuals with certain disabilities.
Medicaid - Answer- Government-based health insurance program for individuals with low incomes
and limited financial resources.
Timely Filing Requirements - Answer- Claims must be submitted within 1 calendar year of the date
of service.
Electronic Data Interchange (EDI) - Answer- Standardized electronic transfer of information.
Coordination of Benefits Rules - Answer- Rules that determine primary and secondary insurance
coverage.
Conditional Payment - Answer- Medicare payment recovered after primary insurance pays.
