NHA - Certified Billing and Coding Specialist (CBCS)
Study Guide || QUESTIONS WITH 100% CORRECT
SOLUTIONS!!
What does the symbol 'O' in the Current Procedural Terminology reference indicate? correct
answers Reinstated or recycled code
What are considered qualifying circumstances in the anesthesia section of the CPT manual?
correct answers 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? correct answers 12
What is considered proper supportive documentation for reporting CPT and ICD codes for
surgical procedures? correct answers Operative report
What is the first action to take when reviewing a delinquent claim? correct answers Verify
the age of the account
For which of the following reasons can a claim be denied or rejected? correct answers Block
24D contains the diagnosis code
What examinations are comprised in a coroner's autopsy? correct answers Gross Examination
Who offers Medigap coverage to Medicare beneficiaries? correct answers Private third-party
payers
Which part of Medicare covers prescriptions? correct answers Part D
Which plane divides the body into left and right? correct answers Sagittal
Where are unlisted codes located in the CPT manual? correct answers Guidelines prior to
each section
What form do ambulatory surgery centers, home health care, and hospice organizations use to
submit claims? correct answers UB-04 Claim Form
What color format is accepted on the CMS-1500 claim form? correct answers Red
Who is responsible for paying the deductible? correct answers Patient
What is the patient's health plan referred to as the 'payer of last resort'? correct answers
Medicaid
Definition: Informed Consent correct answers Providers explain medical procedures, surgical
interventions, benefits, and risks to patients before intervention.
Definition: Implied Consent correct answers Patient's actions imply consent for treatment,
e.g., extending an arm for venipuncture.
, What is the role of a Clearinghouse in medical billing? correct answers Converts claims to
electronic format, checks for errors, and ensures compliance with HIPAA and insurance
standards.
What does 'Individually Identifiable' mean in healthcare documentation? correct answers
Information that can identify a person or provide enough details for identification.
What is 'De-identified Information' in healthcare? correct answers Information with personal
characteristics removed, making it unable to identify an individual.
Consent correct answers A patient's permission evidenced by signature.
Authorizations correct answers Permission granted by the patient or the patient's
representative for purposes other than treatment, payment, or health care operations.
Reimbursement correct answers Payment for services provided by a third-party payer.
Auditing correct answers Reviewing claims for accuracy and completeness.
Fraud correct answers Making false statements to obtain undeserved benefits or payments.
Upcoding correct answers Assigning a higher-level code than supported by documentation,
like coding bronchitis as pneumonia.
Unbundling correct answers Using multiple codes for separate treatment components instead
of a single comprehensive code.
Abuse correct answers Practices leading to unnecessary costs for Medicare.
Business Associate (BA) correct answers Individuals or organizations outside a covered
entity's workforce performing functions for the entity.
Main Role of the Office of the Inspector General (OIG) correct answers Protecting Medicare
and HHS programs from fraud and abuse through audits, investigations, and inspections.
Medicare correct answers Federally funded health insurance for individuals aged 65 or older,
and younger individuals with certain disabilities.
Medicaid correct answers Government-based health insurance program for individuals with
low incomes and limited financial resources.
Timely Filing Requirements correct answers Claims must be submitted within 1 calendar
year of the date of service.
Electronic Data Interchange (EDI) correct answers Standardized electronic transfer of
information.
Coordination of Benefits Rules correct answers Rules that determine primary and secondary
insurance coverage.
Study Guide || QUESTIONS WITH 100% CORRECT
SOLUTIONS!!
What does the symbol 'O' in the Current Procedural Terminology reference indicate? correct
answers Reinstated or recycled code
What are considered qualifying circumstances in the anesthesia section of the CPT manual?
correct answers 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? correct answers 12
What is considered proper supportive documentation for reporting CPT and ICD codes for
surgical procedures? correct answers Operative report
What is the first action to take when reviewing a delinquent claim? correct answers Verify
the age of the account
For which of the following reasons can a claim be denied or rejected? correct answers Block
24D contains the diagnosis code
What examinations are comprised in a coroner's autopsy? correct answers Gross Examination
Who offers Medigap coverage to Medicare beneficiaries? correct answers Private third-party
payers
Which part of Medicare covers prescriptions? correct answers Part D
Which plane divides the body into left and right? correct answers Sagittal
Where are unlisted codes located in the CPT manual? correct answers Guidelines prior to
each section
What form do ambulatory surgery centers, home health care, and hospice organizations use to
submit claims? correct answers UB-04 Claim Form
What color format is accepted on the CMS-1500 claim form? correct answers Red
Who is responsible for paying the deductible? correct answers Patient
What is the patient's health plan referred to as the 'payer of last resort'? correct answers
Medicaid
Definition: Informed Consent correct answers Providers explain medical procedures, surgical
interventions, benefits, and risks to patients before intervention.
Definition: Implied Consent correct answers Patient's actions imply consent for treatment,
e.g., extending an arm for venipuncture.
, What is the role of a Clearinghouse in medical billing? correct answers Converts claims to
electronic format, checks for errors, and ensures compliance with HIPAA and insurance
standards.
What does 'Individually Identifiable' mean in healthcare documentation? correct answers
Information that can identify a person or provide enough details for identification.
What is 'De-identified Information' in healthcare? correct answers Information with personal
characteristics removed, making it unable to identify an individual.
Consent correct answers A patient's permission evidenced by signature.
Authorizations correct answers Permission granted by the patient or the patient's
representative for purposes other than treatment, payment, or health care operations.
Reimbursement correct answers Payment for services provided by a third-party payer.
Auditing correct answers Reviewing claims for accuracy and completeness.
Fraud correct answers Making false statements to obtain undeserved benefits or payments.
Upcoding correct answers Assigning a higher-level code than supported by documentation,
like coding bronchitis as pneumonia.
Unbundling correct answers Using multiple codes for separate treatment components instead
of a single comprehensive code.
Abuse correct answers Practices leading to unnecessary costs for Medicare.
Business Associate (BA) correct answers Individuals or organizations outside a covered
entity's workforce performing functions for the entity.
Main Role of the Office of the Inspector General (OIG) correct answers Protecting Medicare
and HHS programs from fraud and abuse through audits, investigations, and inspections.
Medicare correct answers Federally funded health insurance for individuals aged 65 or older,
and younger individuals with certain disabilities.
Medicaid correct answers Government-based health insurance program for individuals with
low incomes and limited financial resources.
Timely Filing Requirements correct answers Claims must be submitted within 1 calendar
year of the date of service.
Electronic Data Interchange (EDI) correct answers Standardized electronic transfer of
information.
Coordination of Benefits Rules correct answers Rules that determine primary and secondary
insurance coverage.
