NHA CBCS PRACTICE EXAMS ANSWERS AND
QUESTIONS SET A+
✔✔Parentheses - ✔✔Used to enclose supplementary words; non essential modifiers
✔✔Indemnity insurance - ✔✔Health indemnity insurance is a fee for service insurance
that is sometimes used when a person is in between health plans, and will cover some
(but not all) expenses
✔✔Rejected Claim - ✔✔A rejected claim is an electronically submitted claim that is
unprocessable due to missing or invalid information required by the payer.
✔✔77010 - 79999 - ✔✔Radiology
✔✔Medicaid Medically Needy - ✔✔provide Medicaid to certain groups not otherwise
eligible for Medicaid.must cover:
•Pregnant women:
•Children under 18:
•States have option to cover:
•Children up to 21:
•Parents and other caretaker
relatives:
•Elderly:
•Individuals with disabilities:
✔✔Brackets - ✔✔Used to enclose synonyms, alternative wording or and explanatory
phrase
✔✔Modifiers - ✔✔Reporting indicators that indicate that the procedure or service has
been altered by specific circumstance but has not changed in it's definition of code.
✔✔Medicare part A - ✔✔Part A is hospital insurance provided by Medicare. Most
people do not pay a premium for this coverage.
, ✔✔Medicare part B - ✔✔Part B is medical insurance to pay for medically necessary
services and supplies provided by Medicare. (Doctors, outpatient care, Phys. and Occ.
Therapists etc.)
✔✔Medicare part C - ✔✔Part C is the combination of Part A and Part B. The main
difference in Part C is that it is provided through private insurance companies approved
by Medicare.
✔✔Medicare part D - ✔✔Part D is stand-alone prescription drug coverage insurance.
✔✔HMO - ✔✔Health Maintenance Organization. A form of health insurance combining
a range of coverage's in a group basis. A group of doctors and other medical
professionals offer care through the HMO for a flat monthly rate with no deductibles.
✔✔PPO - ✔✔PPO is similar to an HMO, but care is paid for as received instead of in
advance in form of a schedule. PPOs may offer more flexibility by allowing for visits to
out-of-network professionals. Visits within network require only the payment of a small
fee.
✔✔Clean Claim - ✔✔A completed insurance claim form submitted with the program
time limit that contains all the necessary information without deficiencies so it can be
processed and paid promptly.
✔✔Dirty Claim - ✔✔A claim submitted with errors or one that requires manual
processing to resolve problems or is rejected for payment.
✔✔Invalid Claim - ✔✔Any Medicare claim that contains complete, necessary
information but is illogical or incorrect (e.g., listing an incorrect provider number for a
referring physician). Invalid claims re identified to the provider and may be resubmitted
✔✔Advance Beneficiary Notice - (ABN) - ✔✔A notice that a doctor, supplier, or provider
gives a Medicare beneficiary before furnishing an item or service if the doctor, supplier,
or provider believes that Medicare may deny payment.
✔✔Electronic Claim - ✔✔An insurance claim submitted to the insurance carrier via a
central processing unit (CPU), tape, diskette, direct data entry, direct wire, dial-in
telephone, digital fax, or personal computer download or upload
✔✔CMS 1500 Universal Claim Form - ✔✔Developed by the AMA and the Centers for
Medicare and Medicaid Services (CMS). Used by physicians and other professionals to
bill outpatient services and supplies to Tricare, Medicare, some Medicaid programs, and
some private insurance/managed care plans
✔✔What does MAC stand for? - ✔✔Medicare Administrative Contractor
QUESTIONS SET A+
✔✔Parentheses - ✔✔Used to enclose supplementary words; non essential modifiers
✔✔Indemnity insurance - ✔✔Health indemnity insurance is a fee for service insurance
that is sometimes used when a person is in between health plans, and will cover some
(but not all) expenses
✔✔Rejected Claim - ✔✔A rejected claim is an electronically submitted claim that is
unprocessable due to missing or invalid information required by the payer.
✔✔77010 - 79999 - ✔✔Radiology
✔✔Medicaid Medically Needy - ✔✔provide Medicaid to certain groups not otherwise
eligible for Medicaid.must cover:
•Pregnant women:
•Children under 18:
•States have option to cover:
•Children up to 21:
•Parents and other caretaker
relatives:
•Elderly:
•Individuals with disabilities:
✔✔Brackets - ✔✔Used to enclose synonyms, alternative wording or and explanatory
phrase
✔✔Modifiers - ✔✔Reporting indicators that indicate that the procedure or service has
been altered by specific circumstance but has not changed in it's definition of code.
✔✔Medicare part A - ✔✔Part A is hospital insurance provided by Medicare. Most
people do not pay a premium for this coverage.
, ✔✔Medicare part B - ✔✔Part B is medical insurance to pay for medically necessary
services and supplies provided by Medicare. (Doctors, outpatient care, Phys. and Occ.
Therapists etc.)
✔✔Medicare part C - ✔✔Part C is the combination of Part A and Part B. The main
difference in Part C is that it is provided through private insurance companies approved
by Medicare.
✔✔Medicare part D - ✔✔Part D is stand-alone prescription drug coverage insurance.
✔✔HMO - ✔✔Health Maintenance Organization. A form of health insurance combining
a range of coverage's in a group basis. A group of doctors and other medical
professionals offer care through the HMO for a flat monthly rate with no deductibles.
✔✔PPO - ✔✔PPO is similar to an HMO, but care is paid for as received instead of in
advance in form of a schedule. PPOs may offer more flexibility by allowing for visits to
out-of-network professionals. Visits within network require only the payment of a small
fee.
✔✔Clean Claim - ✔✔A completed insurance claim form submitted with the program
time limit that contains all the necessary information without deficiencies so it can be
processed and paid promptly.
✔✔Dirty Claim - ✔✔A claim submitted with errors or one that requires manual
processing to resolve problems or is rejected for payment.
✔✔Invalid Claim - ✔✔Any Medicare claim that contains complete, necessary
information but is illogical or incorrect (e.g., listing an incorrect provider number for a
referring physician). Invalid claims re identified to the provider and may be resubmitted
✔✔Advance Beneficiary Notice - (ABN) - ✔✔A notice that a doctor, supplier, or provider
gives a Medicare beneficiary before furnishing an item or service if the doctor, supplier,
or provider believes that Medicare may deny payment.
✔✔Electronic Claim - ✔✔An insurance claim submitted to the insurance carrier via a
central processing unit (CPU), tape, diskette, direct data entry, direct wire, dial-in
telephone, digital fax, or personal computer download or upload
✔✔CMS 1500 Universal Claim Form - ✔✔Developed by the AMA and the Centers for
Medicare and Medicaid Services (CMS). Used by physicians and other professionals to
bill outpatient services and supplies to Tricare, Medicare, some Medicaid programs, and
some private insurance/managed care plans
✔✔What does MAC stand for? - ✔✔Medicare Administrative Contractor
