NHA CBCS Practice Questions (Set 1) With
Correct Answers
What is the first step in verifying a patient's insurance information?
| | | | | | | | | |
Review the patient's insurnace card for policy number and group number
| | | | | | | | | |
What is the most crucial step in verifying a patient's insurance
| | | | | | | | | | |
information before providing medical services?
| | | |
Verifying a patients eligibility and benefits directly with the insurance
| | | | | | | | | |
company
Which of the following is a primary characteristic of workers'
| | | | | | | | | |
compensation plans? |
They cover medical expenses and lost wages due to work related injuries
| | | | | | | | | | |
What is the primary step a medical billing and coding specialist should
| | | | | | | | | | | |
take when a claim is denied by a third party payer?
| | | | | | | | | |
,Review the Explanation of benefits (EOB) to determine the reason for
| | | | | | | | | | |
denial
When filling a claim with multiple insurance carriers, which insurance
| | | | | | | | | |
should be billed first? | | |
The primary insurance of the patient
| | | | |
When coding from an operative report, which section typically contains
| | | | | | | | | |
the most detailed description of surgical procedure performed?
| | | | | | |
Operative note |
What is the primary purpose of the explanation of benefits (EOB)
| | | | | | | | | | |
document in the revenue cycle management process?
| | | | | |
To outline the patient's payment responsibilities and the payer's payment
| | | | | | | | | |
decisions
Dr. Smith's clinic has recently implemented a compliance plan to ensure
| | | | | | | | | | |
adherence regulatory standards. During an internal audit, it was
| | | | | | | | |
,discovered that an overpayment was received from Medicare for services
| | | | | | | | | |
rendered to a patient named John Doe.
| | | | | |
According to the Provider Self-Disclosure Protocol (SDP), what is the
| | | | | | | | | |
appropriate action Dr. Smith's clinic should take?
| | | | | |
Report the overpayment to Medicare within 60 days
| | | | | | |
Sarah a medical billing and coding specialist is reviewing a claim that was
| | | | | | | | | | | | |
denied by a third-party payer due-to "lack of medical necessity." Which of
| | | | | | | | | | | |
the following actions should Sarah take to address this denial?
| | | | | | | | |
Appeal the denial with supporting documentation from the patient's
| | | | | | | | |
medical record |
John, a 45 year-old employee at a manufacturing company is reviewing
| | | | | | | | | | |
this employee-sponsored health insurance options. He notices that one
| | | | | | | | |
of the plans is a Preferred Provider Organization (PPO) while another is a
| | | | | | | | | | | | |
Health Maintenance Organization (HMO). John values having the
| | | | | | | |
flexibility to see specialists without needing a referral. Which plan should
| | | | | | | | | | |
choose to best meet his needs?
| | | | |
Preferred Provider Organization (PPO)
| | |
, During the pre-authorization process for a complex surgical procedure,
| | | | | | | | |
the insurance company request additional documentation or verify
| | | | | | | |
medical necessity. As the medical billing specialists, how should you
| | | | | | | | | |
clearly and accurately communicate this requirement to Dr. Smith, the
| | | | | | | | | |
surgeon, to ensure timely compliance?
| | | |
Schedule a meeting with Dr. Smith to discuss the specific documents
| | | | | | | | | | |
required and their importance. | | |
Doctor Smith submitted a claim for a patient named John Doe, who under
| | | | | | | | | | | | |
went a minor surgical procedure. The claim was denied due to a code edit
| | | | | | | | | | | | | |
indicating a bundling issue. What should the medical biller do first to
| | | | | | | | | | | |
resolve this issue? | |
Review the National Correct Coding Initiative (NCCI) Edits
| | | | | | |
John a patient is undergoing treatment for a chronic condition. During the
| | | | | | | | | | | |
visit, the healthcare provider discusses the importance of accurately
| | | | | | | | |
documenting his treatment plan and communicating it with the billing
| | | | | | | | | |
department to ensure proper coding and reimbursement. Which of the
| | | | | | | | | |
following steps is most crucial in maintaining regulatory compliance and
| | | | | | | | | |
ensuring accurate communication with stakeholders throughout the
| | | | | | |
revenue cycle? |
Verifying that all treatment codes are entered correctly into the
| | | | | | | | | |
Electronic Health Record (EHR). | | |
Correct Answers
What is the first step in verifying a patient's insurance information?
| | | | | | | | | |
Review the patient's insurnace card for policy number and group number
| | | | | | | | | |
What is the most crucial step in verifying a patient's insurance
| | | | | | | | | | |
information before providing medical services?
| | | |
Verifying a patients eligibility and benefits directly with the insurance
| | | | | | | | | |
company
Which of the following is a primary characteristic of workers'
| | | | | | | | | |
compensation plans? |
They cover medical expenses and lost wages due to work related injuries
| | | | | | | | | | |
What is the primary step a medical billing and coding specialist should
| | | | | | | | | | | |
take when a claim is denied by a third party payer?
| | | | | | | | | |
,Review the Explanation of benefits (EOB) to determine the reason for
| | | | | | | | | | |
denial
When filling a claim with multiple insurance carriers, which insurance
| | | | | | | | | |
should be billed first? | | |
The primary insurance of the patient
| | | | |
When coding from an operative report, which section typically contains
| | | | | | | | | |
the most detailed description of surgical procedure performed?
| | | | | | |
Operative note |
What is the primary purpose of the explanation of benefits (EOB)
| | | | | | | | | | |
document in the revenue cycle management process?
| | | | | |
To outline the patient's payment responsibilities and the payer's payment
| | | | | | | | | |
decisions
Dr. Smith's clinic has recently implemented a compliance plan to ensure
| | | | | | | | | | |
adherence regulatory standards. During an internal audit, it was
| | | | | | | | |
,discovered that an overpayment was received from Medicare for services
| | | | | | | | | |
rendered to a patient named John Doe.
| | | | | |
According to the Provider Self-Disclosure Protocol (SDP), what is the
| | | | | | | | | |
appropriate action Dr. Smith's clinic should take?
| | | | | |
Report the overpayment to Medicare within 60 days
| | | | | | |
Sarah a medical billing and coding specialist is reviewing a claim that was
| | | | | | | | | | | | |
denied by a third-party payer due-to "lack of medical necessity." Which of
| | | | | | | | | | | |
the following actions should Sarah take to address this denial?
| | | | | | | | |
Appeal the denial with supporting documentation from the patient's
| | | | | | | | |
medical record |
John, a 45 year-old employee at a manufacturing company is reviewing
| | | | | | | | | | |
this employee-sponsored health insurance options. He notices that one
| | | | | | | | |
of the plans is a Preferred Provider Organization (PPO) while another is a
| | | | | | | | | | | | |
Health Maintenance Organization (HMO). John values having the
| | | | | | | |
flexibility to see specialists without needing a referral. Which plan should
| | | | | | | | | | |
choose to best meet his needs?
| | | | |
Preferred Provider Organization (PPO)
| | |
, During the pre-authorization process for a complex surgical procedure,
| | | | | | | | |
the insurance company request additional documentation or verify
| | | | | | | |
medical necessity. As the medical billing specialists, how should you
| | | | | | | | | |
clearly and accurately communicate this requirement to Dr. Smith, the
| | | | | | | | | |
surgeon, to ensure timely compliance?
| | | |
Schedule a meeting with Dr. Smith to discuss the specific documents
| | | | | | | | | | |
required and their importance. | | |
Doctor Smith submitted a claim for a patient named John Doe, who under
| | | | | | | | | | | | |
went a minor surgical procedure. The claim was denied due to a code edit
| | | | | | | | | | | | | |
indicating a bundling issue. What should the medical biller do first to
| | | | | | | | | | | |
resolve this issue? | |
Review the National Correct Coding Initiative (NCCI) Edits
| | | | | | |
John a patient is undergoing treatment for a chronic condition. During the
| | | | | | | | | | | |
visit, the healthcare provider discusses the importance of accurately
| | | | | | | | |
documenting his treatment plan and communicating it with the billing
| | | | | | | | | |
department to ensure proper coding and reimbursement. Which of the
| | | | | | | | | |
following steps is most crucial in maintaining regulatory compliance and
| | | | | | | | | |
ensuring accurate communication with stakeholders throughout the
| | | | | | |
revenue cycle? |
Verifying that all treatment codes are entered correctly into the
| | | | | | | | | |
Electronic Health Record (EHR). | | |
