National Healthcareer Association
MAXE · SCBC
★ ★
NHA Certified Billing & Coding Specialist
CBCS
E X C E L L E N C E I N H E A LT H C A R E C R E D E N T I A L I N G
NHA CBCS Exam Review — Certified Billing & Coding
Specialist Complete Q&A
B I L L I N G , CO D I N G , I N S U RA N C E , C L A I M S & H I PA A CO M P L I A N C E
INSTITUTION National Healthcareer Association COURSE CODE CBCS
(NHA)
PROGRAM Certified Billing & Coding ACADEMIC YEAR
Specialist
EXAM TITLE NHA CBCS Exam Review — TOTAL QUESTIONS 100 Questions
Certified Billing & Coding
Specialist Complete Q&A
COURSE TITLE Certified Billing & Coding FORMAT Multiple Choice — Select the
Specialist Single Best Answer
EXAMINATION INSTRUCTIONS
▸ Select the single best answer for each question.
▸ Topics include billing, coding, insurance, claims processing, HIPAA compliance, and medical
terminology.
▸ Correct answers and rationales appear below each question for review purposes.
▸ All content aligns with NHA CBCS exam competencies.
, SECTION I — BILLING, CODING, INSURANCE, CLAIMS &
Questions 1 – 100
HIPAA COMPLIANCE
1. Which of the following Medicare policies determines if a particular item or service is
covered by Medicare?
A. Local Coverage Determination (LCD)
B. National Coverage Determination (NCD)
C. Medicare Administrative Contract (MAC)
D. Advance Beneficiary Notice (ABN)
CORRECT ANSWER B — National Coverage Determination (NCD)
RATIONALE National Coverage Determinations (NCDs) are Medicare policies that determine
whether a particular item or service is covered nationwide. NCDs are issued by
CMS and apply to all Medicare claims. LCDs are local policies issued by MACs,
ABNs are notices given to patients, and MACs are contractors that process claims.
2. A patient's employer has not submitted a premium payment. Which of the following claim
statuses should the provider receive from the third-party payer?
A. Approved
B. Denied
C. Pending
D. Suspended
CORRECT ANSWER B — Denied
RATIONALE When a patient's employer has not submitted a premium payment, the claim will
be denied. The patient's coverage is not active, and the third-party payer will deny
the claim because the patient is not eligible for benefits at the time of service.
,3. A billing and coding specialist should routinely analyze which of the following to
determine the number of outstanding claims?
A. Explanation of Benefits (EOB)
B. Aging report
C. Remittance advice
D. Claim summary
CORRECT ANSWER B — Aging report
RATIONALE An aging report is used to determine the number of outstanding claims and
organize accounts receivable by the date of service. It helps billing specialists
track unpaid claims and identify which accounts require follow-up.
4. Which of the following should a billing and coding specialist use to submit a claim with
supporting documents?
A. Paper claim form
B. Electronic data interchange (EDI)
C. Claims attachment
D. Clearinghouse submission
CORRECT ANSWER C — Claims attachment
RATIONALE A claims attachment is used to submit a claim with supporting documents. It
allows the billing specialist to include additional documentation such as medical
records, operative reports, or other supporting information that may be required
for claim adjudication.
, 5. Which of the following terms is used to communicate why a claim line item was denied or
paid differently than it was billed?
A. Remark codes
B. Claim adjustment codes
C. Denial codes
D. Reason codes
CORRECT ANSWER B — Claim adjustment codes
RATIONALE Claim adjustment codes (also known as CARC - Claim Adjustment Reason Codes)
are used to communicate why a claim line item was denied or paid differently
than it was billed. These standardized codes explain adjustments, denials, and
payment discrepancies on the remittance advice.
6. On a CMS-1500 claim form, which of the following information should the billing and
coding specialist enter into Block 32?
A. Billing provider information
B. Service facility location information
C. Rendering provider information
D. Patient information
CORRECT ANSWER B — Service facility location information
RATIONALE Block 32 on the CMS-1500 claim form contains the service facility location
information. This includes the name, address, and NPI of the facility where the
services were rendered if different from the billing provider's location.
MAXE · SCBC
★ ★
NHA Certified Billing & Coding Specialist
CBCS
E X C E L L E N C E I N H E A LT H C A R E C R E D E N T I A L I N G
NHA CBCS Exam Review — Certified Billing & Coding
Specialist Complete Q&A
B I L L I N G , CO D I N G , I N S U RA N C E , C L A I M S & H I PA A CO M P L I A N C E
INSTITUTION National Healthcareer Association COURSE CODE CBCS
(NHA)
PROGRAM Certified Billing & Coding ACADEMIC YEAR
Specialist
EXAM TITLE NHA CBCS Exam Review — TOTAL QUESTIONS 100 Questions
Certified Billing & Coding
Specialist Complete Q&A
COURSE TITLE Certified Billing & Coding FORMAT Multiple Choice — Select the
Specialist Single Best Answer
EXAMINATION INSTRUCTIONS
▸ Select the single best answer for each question.
▸ Topics include billing, coding, insurance, claims processing, HIPAA compliance, and medical
terminology.
▸ Correct answers and rationales appear below each question for review purposes.
▸ All content aligns with NHA CBCS exam competencies.
, SECTION I — BILLING, CODING, INSURANCE, CLAIMS &
Questions 1 – 100
HIPAA COMPLIANCE
1. Which of the following Medicare policies determines if a particular item or service is
covered by Medicare?
A. Local Coverage Determination (LCD)
B. National Coverage Determination (NCD)
C. Medicare Administrative Contract (MAC)
D. Advance Beneficiary Notice (ABN)
CORRECT ANSWER B — National Coverage Determination (NCD)
RATIONALE National Coverage Determinations (NCDs) are Medicare policies that determine
whether a particular item or service is covered nationwide. NCDs are issued by
CMS and apply to all Medicare claims. LCDs are local policies issued by MACs,
ABNs are notices given to patients, and MACs are contractors that process claims.
2. A patient's employer has not submitted a premium payment. Which of the following claim
statuses should the provider receive from the third-party payer?
A. Approved
B. Denied
C. Pending
D. Suspended
CORRECT ANSWER B — Denied
RATIONALE When a patient's employer has not submitted a premium payment, the claim will
be denied. The patient's coverage is not active, and the third-party payer will deny
the claim because the patient is not eligible for benefits at the time of service.
,3. A billing and coding specialist should routinely analyze which of the following to
determine the number of outstanding claims?
A. Explanation of Benefits (EOB)
B. Aging report
C. Remittance advice
D. Claim summary
CORRECT ANSWER B — Aging report
RATIONALE An aging report is used to determine the number of outstanding claims and
organize accounts receivable by the date of service. It helps billing specialists
track unpaid claims and identify which accounts require follow-up.
4. Which of the following should a billing and coding specialist use to submit a claim with
supporting documents?
A. Paper claim form
B. Electronic data interchange (EDI)
C. Claims attachment
D. Clearinghouse submission
CORRECT ANSWER C — Claims attachment
RATIONALE A claims attachment is used to submit a claim with supporting documents. It
allows the billing specialist to include additional documentation such as medical
records, operative reports, or other supporting information that may be required
for claim adjudication.
, 5. Which of the following terms is used to communicate why a claim line item was denied or
paid differently than it was billed?
A. Remark codes
B. Claim adjustment codes
C. Denial codes
D. Reason codes
CORRECT ANSWER B — Claim adjustment codes
RATIONALE Claim adjustment codes (also known as CARC - Claim Adjustment Reason Codes)
are used to communicate why a claim line item was denied or paid differently
than it was billed. These standardized codes explain adjustments, denials, and
payment discrepancies on the remittance advice.
6. On a CMS-1500 claim form, which of the following information should the billing and
coding specialist enter into Block 32?
A. Billing provider information
B. Service facility location information
C. Rendering provider information
D. Patient information
CORRECT ANSWER B — Service facility location information
RATIONALE Block 32 on the CMS-1500 claim form contains the service facility location
information. This includes the name, address, and NPI of the facility where the
services were rendered if different from the billing provider's location.
