NHA CERTIFIED BILLING AND CODING
SPECIALIST CBCS STUDY GUIDE WITH
ACTUAL EXAM QUESTIONS AND
VERIFIED ANSWERS 100% CORRECT
ANSWERS ALREADY GRADED A+ LATEST
VERSION
"Timely Filing Requirements - CORRECT ANSWER=> Claims must be submitted within 1 calendar
year of the date of service."
"Electronic Data Interchange (EDI) - CORRECT ANSWER=> Standardized electronic transfer of
information."
"Coordination of Benefits Rules - CORRECT ANSWER=> Rules that determine primary and
secondary insurance coverage."
"Conditional Payment - CORRECT ANSWER=> Medicare payment recovered after primary
insurance pays."
"Crossover Claim - CORRECT ANSWER=> Claim submitted to both primary and secondary
insurance plans."
"Assignment of Benefits - CORRECT ANSWER=> Provider bills payer directly and accepts allowable
charge."
"Allowable Charge - CORRECT ANSWER=> Insurer's accepted payment amount, minus cost
sharing."
"Clean Claim - CORRECT ANSWER=> Accurate and complete claim processed in a timely manner."
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, "Dirty Claim - CORRECT ANSWER=> A claim with inaccuracies, incompleteness, or errors."
"Medicare Administrative Contractor (MAC) - CORRECT ANSWER=> Entity processing Medicare
Parts A and B claims from healthcare providers."
"Remittance Advice (RA) - CORRECT ANSWER=> Report sent by the payer to the provider detailing
billing modifications."
"Explanation of Benefits (EOB) - CORRECT ANSWER=> Document outlining services, payments,
and benefit limitations."
"National Provider Identifier (NPI) - CORRECT ANSWER=> Unique 10-digit code for healthcare
providers mandated by HIPAA."
"Health Maintenance Organization (HMO) - CORRECT ANSWER=> Health plan limiting care to
approved providers except in emergencies."
"Modifier - CORRECT ANSWER=> Additional details for CPT or HCPCS codes."
"Purpose of signing block 12 of CMS-1500 form - CORRECT ANSWER=> Authorizing the release of
medical information."
"Claim - CORRECT ANSWER=> Comprehensive record of services and insurance details."
"Location of NPI number on CMS-1500 form - CORRECT ANSWER=> Box 17b"
"What information is typically collected from patients? - CORRECT ANSWER=> Full name and date
of birth."
"Deductible - CORRECT ANSWER=> Amount patient must pay out of pocket before insurance
coverage starts."
"Coinsurance - CORRECT ANSWER=> Percentage of expenses paid by insurance after meeting
deductible."
"Copayment - CORRECT ANSWER=> Fixed dollar amount due per provider visit."
"Medicare Part A - CORRECT ANSWER=> Provides hospitalization insurance."
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SPECIALIST CBCS STUDY GUIDE WITH
ACTUAL EXAM QUESTIONS AND
VERIFIED ANSWERS 100% CORRECT
ANSWERS ALREADY GRADED A+ LATEST
VERSION
"Timely Filing Requirements - CORRECT ANSWER=> Claims must be submitted within 1 calendar
year of the date of service."
"Electronic Data Interchange (EDI) - CORRECT ANSWER=> Standardized electronic transfer of
information."
"Coordination of Benefits Rules - CORRECT ANSWER=> Rules that determine primary and
secondary insurance coverage."
"Conditional Payment - CORRECT ANSWER=> Medicare payment recovered after primary
insurance pays."
"Crossover Claim - CORRECT ANSWER=> Claim submitted to both primary and secondary
insurance plans."
"Assignment of Benefits - CORRECT ANSWER=> Provider bills payer directly and accepts allowable
charge."
"Allowable Charge - CORRECT ANSWER=> Insurer's accepted payment amount, minus cost
sharing."
"Clean Claim - CORRECT ANSWER=> Accurate and complete claim processed in a timely manner."
Page | 1
, "Dirty Claim - CORRECT ANSWER=> A claim with inaccuracies, incompleteness, or errors."
"Medicare Administrative Contractor (MAC) - CORRECT ANSWER=> Entity processing Medicare
Parts A and B claims from healthcare providers."
"Remittance Advice (RA) - CORRECT ANSWER=> Report sent by the payer to the provider detailing
billing modifications."
"Explanation of Benefits (EOB) - CORRECT ANSWER=> Document outlining services, payments,
and benefit limitations."
"National Provider Identifier (NPI) - CORRECT ANSWER=> Unique 10-digit code for healthcare
providers mandated by HIPAA."
"Health Maintenance Organization (HMO) - CORRECT ANSWER=> Health plan limiting care to
approved providers except in emergencies."
"Modifier - CORRECT ANSWER=> Additional details for CPT or HCPCS codes."
"Purpose of signing block 12 of CMS-1500 form - CORRECT ANSWER=> Authorizing the release of
medical information."
"Claim - CORRECT ANSWER=> Comprehensive record of services and insurance details."
"Location of NPI number on CMS-1500 form - CORRECT ANSWER=> Box 17b"
"What information is typically collected from patients? - CORRECT ANSWER=> Full name and date
of birth."
"Deductible - CORRECT ANSWER=> Amount patient must pay out of pocket before insurance
coverage starts."
"Coinsurance - CORRECT ANSWER=> Percentage of expenses paid by insurance after meeting
deductible."
"Copayment - CORRECT ANSWER=> Fixed dollar amount due per provider visit."
"Medicare Part A - CORRECT ANSWER=> Provides hospitalization insurance."
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