NHA CBCS EXAM REVIEW ANSWERED 2022

NHA CBCS EXAM REVIEW ANSWERED 2022 1. Which of the following Medicare policies determines if a particular item or service is covered by Medicare?: National Coverage Determination (NCD) 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?: Denied 3. A billing and coding specialist should routinely analyze which of the following to determine the number of outstanding claims?: Aging report 4. Which of the following should a billing and coding specialist use to submit a claim with supporting documents?: Claims attachment 5. Which of the following terms is used to communicate why a claim line item was denied or paid differently than it was billing?: Claim adjustment codes 6. On a CMS-1500 claim form, which of the following information should the billing and coding specialist enter into Block 32?: Service facility location information 7. A provider's office receives a subpoena requesting medical documenta- tion from a patient's medical record. After confirming the correct authoriza- tion, which of the following actions should the billing and coding specialist take?: Send the medical information pertaining to the dates of service requested 8. Which of the following is the deadline for Medicare claim submission?: 12 months from the date of service 9. Which of the following forms does a third-party payer require for physician services?: CMS-1500 10. A patient who is an active member of the military recently returned from overseas and is in need of specialty care. The patient does not have anyone designed with power of attorney. Which of the following is considered a HIPAA violation?: The billing and coding specialist sends the patient's records to the patient's partner. 11. Which of the following terms refers to the difference between the billing and allowed amounts?: Adjustment 12. Which of the following HMO managed care services requires a referral?- : Durable medical equipment 13. Which of the following explains why Medicare will deny a particular service or procedure?: Advance Beneficiary Notice (ABN) 14. Which of the following types of claims is 120 days old?: Delinquent 15. When reviewing an established patient's insurance card, the billing and coding specialist notices a minor change from the existing card on file. Which of the following actions should the billing and coding specialist take?: Photocopy both sides of the new card 16. A husband and wife each have group insurance through their employers. The wife has an appointment with her provider. Which insurance should be used as primary for the appointment?: The wife's insurance 17. Which of the following would most likely result in a denial on a Medicare claim?: An experimental chemotherapy medication for a patient who has stage III renal cancer 18. Which of the following pieces of guarantor information is required when establishing a patient's financial record?: Phone number 19. A provider surgically punctures through the space between the patient's ribs using an aspirating needle to withdraw fluid from the chest cavity. Which of the following is the name of this procedure?: Pleurocentesis 20. A patient has AARP as secondary insurance. In which of the following blocks on the CMS-1500 claim form should the information be entered?: - Block 9 21. A Medicare non-participating (non-PAR) provider's approved payment amount is $200 for a lobectomy and the deductible has been met. Which of the following amounts is the limiting charge for this procedure?: $230 **A non-PAR who does not accept assignment, can collect a maximum of 15% (the limiting charge) over the non-PAR Medicare fee schedule amount. 22. In the anesthesia section of the CPT manual, which of the following are considered qualifying circumstances?: Add-on codes 23. Threading a catheter with a balloon into a coronary artery and expanding it to repair arteries describes which of the following procedures?: Angioplasty 24. Which of the following actions by a billing and coding specialist would be considered fraud?: Billing for services not provided 25. Which of the following statements is accurate regarding the diagnostic codes in Block 21?: These codes must correspond to the diagnosis pointer in Block 24E 26. Which of the following parts of the Medicare insurance program is man- aged by private, third-party insurance providers that have been approved by Medicare?: Medicare Part C 27. A billing and coding specialist can ensure appropriate insurance cov- erage for an outpatient procedure by first using which of the following processes?: Precertification **Precertification is the first step. Preauthorization is a decision from the payer to approve the service. It is not the first step to determine insurance reimbursement. 28. Which of the following is considered fraud?: The billing and coding special- ist unbundles a code to receive higher reimbursement 29. The authorization number for a service that was approved before the service was rendered is indicated in which of the following blocks on the CMS-1500 claim form?: Block 23 30. A patient is preauthorized to receive vitamin B12 injections from Jan 1 to May 31. On June 2, the provider orders an additional 6 months of injections. In order for the patient to continue with coverage of care, which of the following should occur?: The provider should contact the patient's insurance carrier to obtain a new authorization 31. Which of the following symbols indicates a revised code?: Triangle 32. If both parents have full coverage for a dependent child, which of the following is considered to be the primary insurance holder?: The parent whose birthdate comes first in the calendar year is the primary insurance holder 33. Which of the following entities defines the essential elements of a com- prehensive compliance program?: Office of Inspector General (OIG) 34. The >< symbol is used to indicate new and revised text other than which of the following?: Procedure descriptors 35. Which of the following describes the organization of an aging report?: By date 36. Which of the following is the purpose of coordination of benefits?: Pre- vent multiple insurers from paying benefits covered by other policies 37. A billing and coding specialist submitted a claim to Medicare electroni- cally. No errors were found by the billing software or clearinghouse. Which of the following describes this claim?: Clean claim 38. Which of the following qualifies as an exception to the HIPAA Privacy Rule?: Psychotherapy notes 39. Which of the following would result in a claim being denied?: An italicized code used as the first listed diagnosis 40. Which of the following standardized formats are used in the electronic filing of claims?: HIPAA standard transactions 41. Which of the following describes a two-digit CPT code used to indicate that the provider supervised an interpreted a radiology procedure?: Profes- sional component 42. Which of the following formats are used to submit electronic claims to a third-party payer?: 837 43. Urine moved from the kidneys to the bladder through which of the follow- ing parts of the body?: Ureters 44. 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?: 12 45. Which of the following does a patient sign to allow payment of claims directly to the provider?: Assignment of benefits 46. Which of the following is the primary function of the heart?: Pumping blood in the circulatory system 47. Which of the following is true regarding Medicaid eligibility?: Patient eligibility is determined monthly 48. The explanation of benefits states the amount billed was $80.The allowed amount is $60, and the patient is required to pay a $20 copayment. Which of the following describes the insurance check amount to be posted?: $40 49. Which of the following provisions ensures that an insured's benefits from all insurance companies do not exceed 100% of allowable medical expenses?: Coordination of benefits 50. If a clean claim is received on March 1 of this year, which of the following is the allowable last day of payment in order to meet Medicare compliance requirements?: March 30 51. On a remittance advice form, which of the following is responsible for writing off the difference between the amount billed and the amount allowed by the agreement?: Provider 52. Which of the following is the maximum number of modifiers that the billing and coding specialist can report on a CMS-1500 claim form in Block 24D?: 4 53. When the remittance advice is sent from the third-party payer to the provider, which of the following actions should the billing and coding spe- cialist perform first?: Ensure proper payment has been made 54. Which of the following is a reason a claim would be denied?: Incorrectly linked codes 55. The billing and coding specialist should follow the guidelines in the CPT manual for which of the following reasons?: The guidelines define items that are necessary to accurately code 56. Which of the following documentation is a valid authorization to release medical information to the judicial system?: Subpoena duces tecum 57. A claim is denied due to termination of coverage. Which of the following actions should the billing and coding specialist take next?: Follow up with the patient to determine current name, address, and insurance carrier for resubmission