CBCS – NHA Certified Billing & Coding Specialist Exam Study Guide

CBCS – NHA Certified Billing & Coding Specialist
Exam Study Guide
Colored Attractive Edition • Numbered Questions • Verified Answers – No Year



QUESTION 1
Ambulatory surgery centers, home health care, and hospice organizations use which form to
submit
claims?
■ ANSWER: UB-04 Claim Form

QUESTION 2
What color format is acceptable on the CMS-1500 claim form?
■ ANSWER: Red

QUESTION 3
Who is responsible to pay the deductible?
■ ANSWER: Patient

QUESTION 4
A patient's health plan is referred to as the "payer of last resort." What is the name of that health
plan?
■ ANSWER: Medicaid

QUESTION 5
Informed Consent
Definition: Providers explain medical or diagnostic procedures, surgical interventions,
and the benefits and risks involved, giving patients an opportunity to ask questions before medical
intervention is provided.

QUESTION 6
Implied Consent
Definition: A patient presents for treatment, such as extending an arm to allow a
venipuncture to be performed.

QUESTION 7
Clearinghouse
Definition: Agency that converts claims into standardized electronic format, looks for
errors, and formats them according to HIPAA and insurance standards.

QUESTION 8
Individually Identifiable
Definition: Documents that identify the person or provide enough information
so that the person can be identified.

,QUESTION 9
De-identified Information
Definition: Information that does not identify an individual because unique
and personal characteristics have been removed.

QUESTION 10
Consent
Definition: A patient's permission evidenced by signature.

QUESTION 11
Authorizations
Definition: Permission granted by the patient or the patient's representative to release
information for reasons other than treatment, payment, or health care operations.

QUESTION 12
Reimbursement
Definition: Payment for services rendered from a third-party payer.

QUESTION 13
Auditing
Definition: Review of claims for accuracy and completeness.

QUESTION 14
Fraud
Definition: Making false statements of representations of material facts to obtain some benefit or
payment for which no entitlement would otherwise exist.

QUESTION 15
Upcoding
Definition: Assigning a diagnosis or procedure code at a higher level than the documentation
supports, such as coding bronchitis as pneumonia.

QUESTION 16
Unbundling
Definition: Using multiple codes that describe different components of a treatment instead
of using a single code that describes all steps of the procedure.

QUESTION 17
Abuse
Definition: Practices that directly or indirectly result in unnecessary costs to the Medicare
program.

QUESTION 18
Business Associate (BA)
Definition: Individuals, 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.

, QUESTION 19
The symbol "O" in the Current Procedural Terminology reference is used to indicate what?
■ ANSWER: Reinstated or recycled code

QUESTION 20
In the anesthesia section of the CPT manual, what are considered qualifying circumstances?
■ ANSWER: Add-on codes

QUESTION 21
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

QUESTION 22
What is considered proper supportive documentation for reporting CPT and ICD codes for
surgical
procedures?
■ ANSWER: Operative report

QUESTION 23
What action should be taken first when reviewing a delinquent claim?
■ ANSWER: Verify the age of the
account

QUESTION 24
A claim can be denied or rejected for which of the following reasons?
■ ANSWER: Block 24D contains the
diagnosis code

QUESTION 25
A coroner's autopsy is comprised of what examinations?
■ ANSWER: Gross Examination

QUESTION 26
Medigap coverage is offered to Medicare beneficiaries by whom?
■ ANSWER: Private third-party payers

QUESTION 27
What part of Medicare covers prescriptions?
■ ANSWER: Part C

QUESTION 28
What plane divides the body into left and right?
■ ANSWER: Sagittal