NHA CBCS ANSWERS AND QUESTIONS SET A+
✔✔A managed care organization that establishes a network of providers who care for
their patients is called a/an _________. - ✔✔Preferred Provider Organization (PPO)
✔✔A group that takes nonstandard medical billing software formats and translates them
into the standard Electronic Data Interchange (EDI) formats is called a/an? -
✔✔Clearinghouse
✔✔The out-of-pocket payment amount that a policyholder must meet before insurance
covers the service(s) is called? - ✔✔Deductible
✔✔National Provider Identifier (NPI) number - ✔✔A unique 10-digit number assigned to
providers in the U.S. to identify themselves in all HIPAA transactions.
✔✔What is a capitation? - ✔✔A payment structure in which a health maintenance
organization prepays an annual set fee per patient to a physician.
✔✔A fixed fee collected at the time of the patients visit. - ✔✔Copayment
✔✔A fixed percentage of covered charges applied to the patients bill after the
deductible has been met. - ✔✔Coinsurance
✔✔The charge for keeping the insurance policy in effect. - ✔✔Premium
✔✔Coding and billing that is inconsistent with typical coding and billing practices. -
✔✔Abuse
✔✔How does HIPAA define fraud? - ✔✔An intentional deception of misrepresentation.
✔✔"The difference between fraud and abuse is _______." - ✔✔Intent
✔✔Current Procedural Terminology (CPT) codes - ✔✔Numeric codes developed by the
American Medical Association (AMA) to standardize medical services and procedures.
, ✔✔Is Abuse intentional? - ✔✔No
✔✔What simplified process was developed to enable Medicare beneficiaries to
participate in mass pneumococcal pneumonia virus (PPV) and influenza virus
vaccination programs offered by public health clinics? - ✔✔Roster Billing
✔✔A person filing an appeal is called? - ✔✔Claimant
✔✔Covers injuries caused by insured that occurred on the insured's property. -
✔✔Liability Insurance
✔✔A detailed accounting of the claims for which payment is being made by an
insurance company. The __________ accompanies the payment from the insurance
company. - ✔✔Remittance Advice (RA)
✔✔Authorization by a policyholder that allows a payer to pay benefits directly to a
provider is called? - ✔✔Assignment of Benefits
✔✔A/An ___________ is a person admitted to a hospital or long-term care
facility(LTCF) for treatment with the expectation that the patient will remain in the
hospital for a period of 24 hours or more. - ✔✔Inpatient
✔✔What is confidentiality? - ✔✔Involves restricting patient information access to those
with proper authorization and maintaining the security of patient information.
✔✔The first listed diagnosis can also be referred to as ______________. - ✔✔Principal
diagnosis
✔✔Physicians who enroll in managed care plans are called ______________. They
have contracts with Managed Care Organizations (MCO)s that stipulate their fees. -
✔✔Participating Providers
✔✔A formal, written document that describes how the hospital or physician's practice
ensures rules, regulations, and standards that are being followed is known as a/an
_______________. - ✔✔Compliance Plan
✔✔What act mandated the reporting of ICD-9-CM diagnosis codes? - ✔✔The Medicare
Catastrophic Coverage Act of 1988
✔✔Transmitting electronic medical insurance claims from providers to payers using the
necessary information systems is called ______________. - ✔✔Electronic Data
interchange (EDI)
✔✔A managed care organization that establishes a network of providers who care for
their patients is called a/an _________. - ✔✔Preferred Provider Organization (PPO)
✔✔A group that takes nonstandard medical billing software formats and translates them
into the standard Electronic Data Interchange (EDI) formats is called a/an? -
✔✔Clearinghouse
✔✔The out-of-pocket payment amount that a policyholder must meet before insurance
covers the service(s) is called? - ✔✔Deductible
✔✔National Provider Identifier (NPI) number - ✔✔A unique 10-digit number assigned to
providers in the U.S. to identify themselves in all HIPAA transactions.
✔✔What is a capitation? - ✔✔A payment structure in which a health maintenance
organization prepays an annual set fee per patient to a physician.
✔✔A fixed fee collected at the time of the patients visit. - ✔✔Copayment
✔✔A fixed percentage of covered charges applied to the patients bill after the
deductible has been met. - ✔✔Coinsurance
✔✔The charge for keeping the insurance policy in effect. - ✔✔Premium
✔✔Coding and billing that is inconsistent with typical coding and billing practices. -
✔✔Abuse
✔✔How does HIPAA define fraud? - ✔✔An intentional deception of misrepresentation.
✔✔"The difference between fraud and abuse is _______." - ✔✔Intent
✔✔Current Procedural Terminology (CPT) codes - ✔✔Numeric codes developed by the
American Medical Association (AMA) to standardize medical services and procedures.
, ✔✔Is Abuse intentional? - ✔✔No
✔✔What simplified process was developed to enable Medicare beneficiaries to
participate in mass pneumococcal pneumonia virus (PPV) and influenza virus
vaccination programs offered by public health clinics? - ✔✔Roster Billing
✔✔A person filing an appeal is called? - ✔✔Claimant
✔✔Covers injuries caused by insured that occurred on the insured's property. -
✔✔Liability Insurance
✔✔A detailed accounting of the claims for which payment is being made by an
insurance company. The __________ accompanies the payment from the insurance
company. - ✔✔Remittance Advice (RA)
✔✔Authorization by a policyholder that allows a payer to pay benefits directly to a
provider is called? - ✔✔Assignment of Benefits
✔✔A/An ___________ is a person admitted to a hospital or long-term care
facility(LTCF) for treatment with the expectation that the patient will remain in the
hospital for a period of 24 hours or more. - ✔✔Inpatient
✔✔What is confidentiality? - ✔✔Involves restricting patient information access to those
with proper authorization and maintaining the security of patient information.
✔✔The first listed diagnosis can also be referred to as ______________. - ✔✔Principal
diagnosis
✔✔Physicians who enroll in managed care plans are called ______________. They
have contracts with Managed Care Organizations (MCO)s that stipulate their fees. -
✔✔Participating Providers
✔✔A formal, written document that describes how the hospital or physician's practice
ensures rules, regulations, and standards that are being followed is known as a/an
_______________. - ✔✔Compliance Plan
✔✔What act mandated the reporting of ICD-9-CM diagnosis codes? - ✔✔The Medicare
Catastrophic Coverage Act of 1988
✔✔Transmitting electronic medical insurance claims from providers to payers using the
necessary information systems is called ______________. - ✔✔Electronic Data
interchange (EDI)
