NHA - Certified Billing and Coding Specialist Study Guide 2025
A billing and coding specialist can ensure appropriate insurance coverage for an outpatient procedure by
obtaining what? - ansPrecertification
A claim can be denied or rejected for which of the following reasons? - ansBlock 24D contains the diagnosis
code
A coroner's autopsy is comprised of what examinations? - ansGross Examination
A patient's health plan is referred to as the "payer of last resort." What is the name of that health plan? -
ansMedicaid
Abstracting - ansThe extraction of specific data from a medical record, often for use in an external database,
such as a cancer registry.
Abuse - ansPractices that directly or indirectly result in unnecessary costs to the Medicare program.
Account Number - ansNumber that identifies specific episode of care, date of service, or patient.
Accounts Receivable Department - ansDepartment that keeps track of what third-party payers the provider is
waiting to hear from and what patients are due to make a payment.
Advance Beneficiary Notice of Noncoverage - ansForm provided if a provider believes that a service may be
declined because Medicare might consider it unnecessary.
Aging Report - ansMeasures the outstanding balances in each account.
Allowable Charge - ansThe amount an insurer will accept as full payment, minus applicable cost sharing.
, Ambulatory surgery centers, home health care, and hospice organizations use which form to submit claims? -
ansUB-04 Claim Form
APC Grouper - ansHelps coders determine the appropriate ambulatory payment classification (APC) for an
outpatient encounter.
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? - ans12
Assignment of Benefits - ansContract in which the provider directly bills the payer and accepts the allowable
charge.
At what percentage should a front torso burn be coded? - ans18%
Auditing - ansReview of claims for accuracy and completeness.
Authorizations - ansPermission granted by the patient or the patient's representative to release information for
reasons other than treatment, payment, or health care operations.
Balance Billing - ansBilling patients for charges in excess of the Medicare fee schedule.
Batch - ansA group of submitted claims.
Block 17b on the CMS-1500 claim form should list what information? - ansReferring physician's national
provider identifier number.
Business Associate (BA) - ansIndividuals, groups, or organizations who are not members of a covered entity's
workforce that perform functions or activities on behalf of or for a covered entity.
A billing and coding specialist can ensure appropriate insurance coverage for an outpatient procedure by
obtaining what? - ansPrecertification
A claim can be denied or rejected for which of the following reasons? - ansBlock 24D contains the diagnosis
code
A coroner's autopsy is comprised of what examinations? - ansGross Examination
A patient's health plan is referred to as the "payer of last resort." What is the name of that health plan? -
ansMedicaid
Abstracting - ansThe extraction of specific data from a medical record, often for use in an external database,
such as a cancer registry.
Abuse - ansPractices that directly or indirectly result in unnecessary costs to the Medicare program.
Account Number - ansNumber that identifies specific episode of care, date of service, or patient.
Accounts Receivable Department - ansDepartment that keeps track of what third-party payers the provider is
waiting to hear from and what patients are due to make a payment.
Advance Beneficiary Notice of Noncoverage - ansForm provided if a provider believes that a service may be
declined because Medicare might consider it unnecessary.
Aging Report - ansMeasures the outstanding balances in each account.
Allowable Charge - ansThe amount an insurer will accept as full payment, minus applicable cost sharing.
, Ambulatory surgery centers, home health care, and hospice organizations use which form to submit claims? -
ansUB-04 Claim Form
APC Grouper - ansHelps coders determine the appropriate ambulatory payment classification (APC) for an
outpatient encounter.
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? - ans12
Assignment of Benefits - ansContract in which the provider directly bills the payer and accepts the allowable
charge.
At what percentage should a front torso burn be coded? - ans18%
Auditing - ansReview of claims for accuracy and completeness.
Authorizations - ansPermission granted by the patient or the patient's representative to release information for
reasons other than treatment, payment, or health care operations.
Balance Billing - ansBilling patients for charges in excess of the Medicare fee schedule.
Batch - ansA group of submitted claims.
Block 17b on the CMS-1500 claim form should list what information? - ansReferring physician's national
provider identifier number.
Business Associate (BA) - ansIndividuals, groups, or organizations who are not members of a covered entity's
workforce that perform functions or activities on behalf of or for a covered entity.
