NHA - Certified Billing and Coding
Specialist (CBCS) Study Guide
The symbol "O" in the Current Procedural Terminology reference is used to indicate what?
- Reinstated or recycled code
In the anesthesia section of the CPT manual, what are considered qualifying circumstances?
- Add-on codes
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
What is considered proper supportive documentation for reporting CPT and ICD codes for
surgical procedures? - Operative report
What action should be taken first when reviewing a delinquent claim? - Verify the age of
the account
A claim can be denied or rejected for which of the following reasons? - Block 24D contains
the diagnosis code
A coroner's autopsy is comprised of what examinations? - Gross Examination
Medigap coverage is offered to Medicare beneficiaries by whom? - Private third-party
payers
What part of Medicare covers prescriptions? - Part C
What plane divides the body into left and right? - Sagittal
Where can unlisted codes be found in the CPT manual? - Guidelines prior to each section
Ambulatory surgery centers, home health care, and hospice organizations use which form
to submit claims? - UB-04 Claim Form
What color format is acceptable on the CMS-1500 claim form? - Red
Who is responsible to pay the deductible? - Patient
A patient's health plan is referred to as the "payer of last resort." What is the name of that
health plan? - Medicaid
, Informed Consent - Providers explain medical or diagnostic procedures, surgical
interventions, and the benefits and risks involved, giving patients an opportunity to ask
questions before medical intervention is provided.
Implied Consent - A patient presents for treatment, such as extending an arm to allow a
venipuncture to be performed.
Clearinghouse - Agency that converts claims into standardized electronic format, looks for
errors, and formats them according to HIPAA and insurance standards.
Individually Identifiable - Documents that identify the person or provide enough
information so that the person can be identified.
De-identified Information - Information that does not identify an individual because unique
and personal characteristics have been removed.
Consent - A patient's permission evidenced by signature.
Authorizations - Permission granted by the patient or the patient's representative to
release information for reasons other than treatment, payment, or health care operations.
Reimbursement - Payment for services rendered from a third-party payer.
Auditing - Review of claims for accuracy and completeness.
Fraud - Making false statements of representations of material facts to obtain some benefit
or payment for which no entitlement would otherwise exist.
Upcoding - Assigning a diagnosis or procedure code at a higher level than the
documentation supports, such as coding bronchitis as pneumonia.
Unbundling - Using multiple codes that describe different components of a treatment
instead of using a single code that describes all steps of the procedure.
Abuse - Practices that directly or indirectly result in unnecessary costs to the Medicare
program.
Business Associate (BA) - Individuals, groups, or organizations who are not members of a
covered entity's workforce that perform functions or activities on behalf of or for a covered
entity.
What is the main job of the Office of the Inspector General (OIG)? - The OIG protects
Medicare and other HHS programs from fraud and abuse by conducting audits,
investigations , and inspections.
Specialist (CBCS) Study Guide
The symbol "O" in the Current Procedural Terminology reference is used to indicate what?
- Reinstated or recycled code
In the anesthesia section of the CPT manual, what are considered qualifying circumstances?
- Add-on codes
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
What is considered proper supportive documentation for reporting CPT and ICD codes for
surgical procedures? - Operative report
What action should be taken first when reviewing a delinquent claim? - Verify the age of
the account
A claim can be denied or rejected for which of the following reasons? - Block 24D contains
the diagnosis code
A coroner's autopsy is comprised of what examinations? - Gross Examination
Medigap coverage is offered to Medicare beneficiaries by whom? - Private third-party
payers
What part of Medicare covers prescriptions? - Part C
What plane divides the body into left and right? - Sagittal
Where can unlisted codes be found in the CPT manual? - Guidelines prior to each section
Ambulatory surgery centers, home health care, and hospice organizations use which form
to submit claims? - UB-04 Claim Form
What color format is acceptable on the CMS-1500 claim form? - Red
Who is responsible to pay the deductible? - Patient
A patient's health plan is referred to as the "payer of last resort." What is the name of that
health plan? - Medicaid
, Informed Consent - Providers explain medical or diagnostic procedures, surgical
interventions, and the benefits and risks involved, giving patients an opportunity to ask
questions before medical intervention is provided.
Implied Consent - A patient presents for treatment, such as extending an arm to allow a
venipuncture to be performed.
Clearinghouse - Agency that converts claims into standardized electronic format, looks for
errors, and formats them according to HIPAA and insurance standards.
Individually Identifiable - Documents that identify the person or provide enough
information so that the person can be identified.
De-identified Information - Information that does not identify an individual because unique
and personal characteristics have been removed.
Consent - A patient's permission evidenced by signature.
Authorizations - Permission granted by the patient or the patient's representative to
release information for reasons other than treatment, payment, or health care operations.
Reimbursement - Payment for services rendered from a third-party payer.
Auditing - Review of claims for accuracy and completeness.
Fraud - Making false statements of representations of material facts to obtain some benefit
or payment for which no entitlement would otherwise exist.
Upcoding - Assigning a diagnosis or procedure code at a higher level than the
documentation supports, such as coding bronchitis as pneumonia.
Unbundling - Using multiple codes that describe different components of a treatment
instead of using a single code that describes all steps of the procedure.
Abuse - Practices that directly or indirectly result in unnecessary costs to the Medicare
program.
Business Associate (BA) - Individuals, groups, or organizations who are not members of a
covered entity's workforce that perform functions or activities on behalf of or for a covered
entity.
What is the main job of the Office of the Inspector General (OIG)? - The OIG protects
Medicare and other HHS programs from fraud and abuse by conducting audits,
investigations , and inspections.
