NHA CBCS Study Guide || QUESTIONS WITH
COMPLETE SOLUTIONS; GUARANTEED PASS!!
Medicare Part A correct answers Covers home health care, skilled services, and hospice care
for terminally ill patients.
Medicare Part B correct answers Covers outpatient hospital services and home health services
not covered by Part A.
Medicare Part C correct answers Covers Medicare Advantage Plans.
Medicare Part D correct answers 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. correct answers Claims
adjustment reason code
An unlisted code is a CPT procedure code that is used for unusual procedures that have no
listed codes. correct answers Unlisted Code
A taxonomy code is used to identify specialty training for providers. correct answers
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. correct answers Fee-for-Service
A guarantor is the patient or another authorized party responsible for the patient's health bill.
correct answers Guarantor
An insurance company. that offers plans that pay health care providers who render services to
patients is a third-party payer. correct answers Third Party Payer
Abusive Billing Pattern correct answers 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. correct answers 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? correct answers Fraud
During which of the following steps of the revenue cycle does effective communication
begin? correct answers Registration and Scheduling
Which of the following is a claim that is possible to adjudicate and includes all required data
elements? correct answers Clean Claim
, A billing and coding specialist should identify that the Office of Inspector General (OIG) has
which of the following roles? correct answers 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? correct answers To
investigate potential improper Medicare payments
Which of the following is an effective tool for collecting a patient's payment for health care
service? correct answers Communication
Which of the following requires a patient's authorization prior to disclosure? correct answers
Protected health information (PHI)
Which of the following refers to the act of controlling access to records, protecting patient
health information from destruction or loss, and providing employee training? correct
answers Security
Which of the following actions by a billing and coding specialist represents a breach of
confidentiality? correct answers Discussing patient information in the elevator where other
patients are present
A billing and coding specialist is speaking with a patient on the telephone about their plan
benefits. Which of the following actions should the specialist take when communicating with
the patient? correct answers Explain patient financial responsibility
a billing and coding specialist is processing claims. Which of the following should the
specialist identify as an example of fraud? correct answers Upcoding for increased
reimbursement
A billing and coding specialist is preparing to code an anesthesiologist's portion of a
procedure. The specialist must be able to identify the correct start/stop times to code the
claim correctly. Which of the following regulates this activity? correct answers CPT
Guidelines
A billing and coding specialist should identify that which of the following documents assists
providers in determining whether there are any outstanding claims? correct answers Aging
Report
Which of the following terms describes a patient's right to have their protected health
information safeguard and not disclosed to others without their permission? correct answers
Privacy
Which of the following parts of Medicare determines eligibility for dental services? correct
answers Part C
A patient who has Medicare coverage requests a pain medication refill following hip
replacement surgery. For which of the following parts of Medicare should the patient's
eligibility be verified for the prescription? correct answers Part D
COMPLETE SOLUTIONS; GUARANTEED PASS!!
Medicare Part A correct answers Covers home health care, skilled services, and hospice care
for terminally ill patients.
Medicare Part B correct answers Covers outpatient hospital services and home health services
not covered by Part A.
Medicare Part C correct answers Covers Medicare Advantage Plans.
Medicare Part D correct answers 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. correct answers Claims
adjustment reason code
An unlisted code is a CPT procedure code that is used for unusual procedures that have no
listed codes. correct answers Unlisted Code
A taxonomy code is used to identify specialty training for providers. correct answers
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. correct answers Fee-for-Service
A guarantor is the patient or another authorized party responsible for the patient's health bill.
correct answers Guarantor
An insurance company. that offers plans that pay health care providers who render services to
patients is a third-party payer. correct answers Third Party Payer
Abusive Billing Pattern correct answers 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. correct answers 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? correct answers Fraud
During which of the following steps of the revenue cycle does effective communication
begin? correct answers Registration and Scheduling
Which of the following is a claim that is possible to adjudicate and includes all required data
elements? correct answers Clean Claim
, A billing and coding specialist should identify that the Office of Inspector General (OIG) has
which of the following roles? correct answers 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? correct answers To
investigate potential improper Medicare payments
Which of the following is an effective tool for collecting a patient's payment for health care
service? correct answers Communication
Which of the following requires a patient's authorization prior to disclosure? correct answers
Protected health information (PHI)
Which of the following refers to the act of controlling access to records, protecting patient
health information from destruction or loss, and providing employee training? correct
answers Security
Which of the following actions by a billing and coding specialist represents a breach of
confidentiality? correct answers Discussing patient information in the elevator where other
patients are present
A billing and coding specialist is speaking with a patient on the telephone about their plan
benefits. Which of the following actions should the specialist take when communicating with
the patient? correct answers Explain patient financial responsibility
a billing and coding specialist is processing claims. Which of the following should the
specialist identify as an example of fraud? correct answers Upcoding for increased
reimbursement
A billing and coding specialist is preparing to code an anesthesiologist's portion of a
procedure. The specialist must be able to identify the correct start/stop times to code the
claim correctly. Which of the following regulates this activity? correct answers CPT
Guidelines
A billing and coding specialist should identify that which of the following documents assists
providers in determining whether there are any outstanding claims? correct answers Aging
Report
Which of the following terms describes a patient's right to have their protected health
information safeguard and not disclosed to others without their permission? correct answers
Privacy
Which of the following parts of Medicare determines eligibility for dental services? correct
answers Part C
A patient who has Medicare coverage requests a pain medication refill following hip
replacement surgery. For which of the following parts of Medicare should the patient's
eligibility be verified for the prescription? correct answers Part D
