CBCS Practice for NHA
Reinstated or recycled code - Answer -The symbol "O" in the Current Procedural Terminology reference
is used to indicate what?
Add-on codes - Answer -In the anesthesia section of the CPT manual, what are considered qualifying
circumstances?
Operative Report - Answer -What is considered proper supportive documentation for reporting CPT and
ICD codes for surgical procedures?
Guidelines prior to each section - Answer -Where can unlisted codes be found in the CPT manual.
17b - Answer -Where does the NPI number go on the CMS-1500 form?
Electronic Data Interchange - Answer -The transfer of electronic information in a standard form.
Explanation of Benefits (EOB) - Answer -Describes the services rendered, payment covered, and benefit
limits and denials.
Crossover Claim - Answer -Claim submitted by people covered by a primary and secondary insurance
plan.
,Authorizes the release of medical information. - Answer -By signing block 12 of CMS-1500 form, a
patient is doing what?
Medicare Part A - Answer -Provides hospitalization insurance to eligible individuals.
Medicare Part B - Answer -Voluntary supplemental medical insurance to help pay for physicians' and
other medical professionals' services, medical services, and medical-surgical supplies not covered by
Medicare Part A.
Medicare Advantage (MA) - Answer -Combined package of benefits under Medicare Parts A and B that
may offer extra coverage for services such as vision, hearing, dental, health and wellness, or prescription
drug coverage.
Medicare Part D - Answer -prescription drug coverage by Medicare
Medigap - Answer -A private health insurance that pays for most of the charges not covered by
Medicare Parts A and B.
PreAUTHORIZATION - Answer -Approval from the health plan for an inpatient hospital stay or surgery.
PreCERTIFICATION - Answer -A review that looks at whether the procedure could be performed safely
but less expensively in an outpatient setting.
PreDETERMINATION - Answer -A written request for a verification of benefits.
Who is usually the Gatekeeper? - Answer -The primary physician.
Formulary - Answer -A list of prescription drugs covered by an insurance plan.
Tier 1 - Answer -Providers and facilities in a PPO's network.
, Tier 2 - Answer -Providers and facilities within a broader, contracted network of the insurance company.
Tier 3 - Answer -Providers and facilities out of the network.
Tier 4 - Answer -Providers and facilities not on the formulary.
Preferred Provider - Answer -Tier 2 provider
Charge Description Master (CDM) - Answer -Information about health care services that patients have
received and financial transactions that have taken place.
Balance Billing - Answer -Billing patients for charges in excess of the Medicare fee schedule.
Batch - Answer -A group of submitted claims.
V Codes - Answer -Codes used to classify visits when circumstances other than disease or injury are the
reason for the appointment.
E Codes - Answer -Codes used to classify environmental events, circumstances, and conditions, such as
the cause of injury, poisoning, and other adverse events.
Category 1 CPT Code - Answer -Code that covers physicians' services and hospital outpatient coding.
Category 2 CPT Code - Answer -Code designed to serve as supplemental tracking codes that can be used
for performance measurement.
Category 3 CPT Code - Answer -Code used for temporary coding for new technology and services that
have not met the requirements needed to be added to the main section of the CPT book.
Abstracting - Answer -The extraction of specific data from a medical record, often for use in an external
database, such as a cancer registry.
Reinstated or recycled code - Answer -The symbol "O" in the Current Procedural Terminology reference
is used to indicate what?
Add-on codes - Answer -In the anesthesia section of the CPT manual, what are considered qualifying
circumstances?
Operative Report - Answer -What is considered proper supportive documentation for reporting CPT and
ICD codes for surgical procedures?
Guidelines prior to each section - Answer -Where can unlisted codes be found in the CPT manual.
17b - Answer -Where does the NPI number go on the CMS-1500 form?
Electronic Data Interchange - Answer -The transfer of electronic information in a standard form.
Explanation of Benefits (EOB) - Answer -Describes the services rendered, payment covered, and benefit
limits and denials.
Crossover Claim - Answer -Claim submitted by people covered by a primary and secondary insurance
plan.
,Authorizes the release of medical information. - Answer -By signing block 12 of CMS-1500 form, a
patient is doing what?
Medicare Part A - Answer -Provides hospitalization insurance to eligible individuals.
Medicare Part B - Answer -Voluntary supplemental medical insurance to help pay for physicians' and
other medical professionals' services, medical services, and medical-surgical supplies not covered by
Medicare Part A.
Medicare Advantage (MA) - Answer -Combined package of benefits under Medicare Parts A and B that
may offer extra coverage for services such as vision, hearing, dental, health and wellness, or prescription
drug coverage.
Medicare Part D - Answer -prescription drug coverage by Medicare
Medigap - Answer -A private health insurance that pays for most of the charges not covered by
Medicare Parts A and B.
PreAUTHORIZATION - Answer -Approval from the health plan for an inpatient hospital stay or surgery.
PreCERTIFICATION - Answer -A review that looks at whether the procedure could be performed safely
but less expensively in an outpatient setting.
PreDETERMINATION - Answer -A written request for a verification of benefits.
Who is usually the Gatekeeper? - Answer -The primary physician.
Formulary - Answer -A list of prescription drugs covered by an insurance plan.
Tier 1 - Answer -Providers and facilities in a PPO's network.
, Tier 2 - Answer -Providers and facilities within a broader, contracted network of the insurance company.
Tier 3 - Answer -Providers and facilities out of the network.
Tier 4 - Answer -Providers and facilities not on the formulary.
Preferred Provider - Answer -Tier 2 provider
Charge Description Master (CDM) - Answer -Information about health care services that patients have
received and financial transactions that have taken place.
Balance Billing - Answer -Billing patients for charges in excess of the Medicare fee schedule.
Batch - Answer -A group of submitted claims.
V Codes - Answer -Codes used to classify visits when circumstances other than disease or injury are the
reason for the appointment.
E Codes - Answer -Codes used to classify environmental events, circumstances, and conditions, such as
the cause of injury, poisoning, and other adverse events.
Category 1 CPT Code - Answer -Code that covers physicians' services and hospital outpatient coding.
Category 2 CPT Code - Answer -Code designed to serve as supplemental tracking codes that can be used
for performance measurement.
Category 3 CPT Code - Answer -Code used for temporary coding for new technology and services that
have not met the requirements needed to be added to the main section of the CPT book.
Abstracting - Answer -The extraction of specific data from a medical record, often for use in an external
database, such as a cancer registry.
