NHA CBCS CERTIFICATION EXAM 2025.
(CORRECT ANSWERS)
Which of the following is considered the final determination of the issues involving settlement of an insurance
q q q q q q q q q q q q q q q q
claim? - correct answer Adjudication
q q q q q
A form that contains charges, DOS, CPT codes, ICD codes, fees and copayment information is called which of
q q q q q q q q q q q q q q q q q q
the following? - correct answer Encounter form
q q q q q q
A patient comes to the hospital for an inpatient procedure. Which of the following hospital staff members is
q q q q q q q q q q q q q q q q q q
responsible for the initial patient interview, obtaining demographic and insurance information, and
q q q q q q q q q q q q
documenting the chief complaint? - correct answer Admitting clerk
q q q q q q q q
Which of the following privacy measures ensures protected health information (phi)? - correct answer Using
q q q q q q q q q q q q q q q
data encryption software on office workstations
q q q q q
Which of the following planes divides the body into left and right? - correct answer Sagittal
q q q q q q q q q q q q q q q
Which of the following provisions ensures that an insured's benefits from all insurance companies do not
q q q q q q q q q q q q q q q q
exceed 100% of allowable medical expenses? - correct answer Coordination of benefits
q q q q q q q q q q q
Which of the following actions should be taken first when reviewing a delinquent claim? - correct answer
q q q q q q q q q q q q q q q q q
Verify the age of the account
q q q q q
,Which of the following is the advantage of electronic claim submission? - correct answer Claims are expedited
q q q q q q q q q q q q q q q q
Which of the following components of an explanation of benefits expedites the process of a phone appeal? -
q q q q q q q q q q q q q q q q q q
correct answer Claim control number
q q q q
The standard medical abbreviation ECG refers to a test used to assess which of the following body systems? -
q q q q q q q q q q q q q q q q q q q
correct answer Cardiovascular system
q q q
Which of the following actions by a billing and coding specialist would be considered fraud? - correct answer
q q q q q q q q q q q q q q q q q q
Billing for services not provided
q q q q
The >< symbol is used to indicate a new and revised test other than which of the following? - correct answer
q q q q q q q q q q q q q q q q q q q q q
Procedure descriptors q
On the CMS-1500 claim form, blocks 14 through 33 contain information about which of the following? -
q q q q q q q q q q q q q q q q q
correct answer The patient's condition and the provider's information
q q q q q q q q
Which of the following includes procedures and best practices for correct coding? - correct answer Coding
q q q q q q q q q q q q q q q q
Compliance Plan q
When completing a CMS-1500 paper claim form, which of the following is an acceptable action for the billing
q q q q q q q q q q q q q q q q q q
and coding specialist to take? - correct answer Use arial size 10 font
q q q q q q q q q q q q
A participating blue cross/blue shield (BC/BS) provider receives an explanation of benefits for a patient
q q q q q q q q q q q q q q q
account. The charged amount was $100. BC/BS allowed $80 and applied $40 to the patient's annual
q q q q q q q q q q q q q q q q
deductible. BC/BS paid the balance at 80%. How much should the patient expect to pay? - correct answer $48
q q q q q q q q q q q q q q q q q q
Which of the following indicates a claim should be submitted on paper instead of electronically? - correct
q q q q q q q q q q q q q q q q q
answer The claim requires an attachment
q q q q q
According to HIPAA standards, which of the following identifies the rendering provider on the CMS-1500
q q q q q q q q q q q q q q q
claim form in block 24j? - correct answer NPI
q q q q q q q q
, Which of the following blocks should the billing and coding specialist complete on the CMS-1500 claim form
q q q q q q q q q q q q q q q q q
form for procedures, services or supplies (CPT/HCPCS)? - correct answer Block 24D
q q q q q q q q q q q
Which of the following terms describes when a plan pays 70% of the allowed amount and the patient pays
q q q q q q q q q q q q q q q q q q q
30%? - correct answer Coinsurance
q q q q
A provider charged $500 to claim that had an allowable amount of $400. In which of the following columns
q q q q q q q q q q q q q q q q q q q
should the billing and coding specialist apply the non-allowed charge? - correct answer Adjustment column of
q q q q q q q q q q q q q q q
the credits
q q
Which of the following is a HIPAA compliance guideline affecting electronic health records? - correct answer
q q q q q q q q q q q q q q q q
The electronic transmission and code set standards require every provider to use the healthcare transactions
q q q q q q q q q q q q q q q
,code sets and identifiers q q q
Patient: Jane Austin; Social Security # 555-22-1111; Medicare ID: 555-33-2222A; DOB: 05/22/1945. Claim
q q q q q q q q q q q q q
information entered: Austin, Jane; Social Security #.: 555-22-1111; Medicare ID No.: 555-33-2222A; DOB:
q q q q q q q q q q q q q
052245. Which of the following is a reason this claim was rejected? - correct answer The DOB is entered
q q q q q q q q q q q q q q q q q q q
incorrectly
Why does correct claim processing rely on accurately completed encounter forms? - correct answer They
q q q q q q q q q q q q q q q
streamline patient billing by summarizing the services rendered for a given date of service
q q q q q q q q q q q q q
A patient's health plan is referred to as the "payer of last resort." The patient is covered by which of the
q q q q q q q q q q q q q q q q q q q q q
following health plans? - correct answer Medicaid q q q q q q
Which of the following color formats is acceptable on the CMS-1500 claim form? - correct answer Red
q q q q q q q q q q q q q q q q
Which of the following is an example of a violation of an adult patient's confidentiality? - correct answer
q q q q q q q q q q q q q q q q q q
Patient information was disclosed to the patient's parents without consent.
q q q q q q q q q
In the anesthesia section of the CPT manual, which of the following are considered qualifying circumstances?
q q q q q q q q q q q q q q q q
- correct answer Add-on codes
q q q q
(CORRECT ANSWERS)
Which of the following is considered the final determination of the issues involving settlement of an insurance
q q q q q q q q q q q q q q q q
claim? - correct answer Adjudication
q q q q q
A form that contains charges, DOS, CPT codes, ICD codes, fees and copayment information is called which of
q q q q q q q q q q q q q q q q q q
the following? - correct answer Encounter form
q q q q q q
A patient comes to the hospital for an inpatient procedure. Which of the following hospital staff members is
q q q q q q q q q q q q q q q q q q
responsible for the initial patient interview, obtaining demographic and insurance information, and
q q q q q q q q q q q q
documenting the chief complaint? - correct answer Admitting clerk
q q q q q q q q
Which of the following privacy measures ensures protected health information (phi)? - correct answer Using
q q q q q q q q q q q q q q q
data encryption software on office workstations
q q q q q
Which of the following planes divides the body into left and right? - correct answer Sagittal
q q q q q q q q q q q q q q q
Which of the following provisions ensures that an insured's benefits from all insurance companies do not
q q q q q q q q q q q q q q q q
exceed 100% of allowable medical expenses? - correct answer Coordination of benefits
q q q q q q q q q q q
Which of the following actions should be taken first when reviewing a delinquent claim? - correct answer
q q q q q q q q q q q q q q q q q
Verify the age of the account
q q q q q
,Which of the following is the advantage of electronic claim submission? - correct answer Claims are expedited
q q q q q q q q q q q q q q q q
Which of the following components of an explanation of benefits expedites the process of a phone appeal? -
q q q q q q q q q q q q q q q q q q
correct answer Claim control number
q q q q
The standard medical abbreviation ECG refers to a test used to assess which of the following body systems? -
q q q q q q q q q q q q q q q q q q q
correct answer Cardiovascular system
q q q
Which of the following actions by a billing and coding specialist would be considered fraud? - correct answer
q q q q q q q q q q q q q q q q q q
Billing for services not provided
q q q q
The >< symbol is used to indicate a new and revised test other than which of the following? - correct answer
q q q q q q q q q q q q q q q q q q q q q
Procedure descriptors q
On the CMS-1500 claim form, blocks 14 through 33 contain information about which of the following? -
q q q q q q q q q q q q q q q q q
correct answer The patient's condition and the provider's information
q q q q q q q q
Which of the following includes procedures and best practices for correct coding? - correct answer Coding
q q q q q q q q q q q q q q q q
Compliance Plan q
When completing a CMS-1500 paper claim form, which of the following is an acceptable action for the billing
q q q q q q q q q q q q q q q q q q
and coding specialist to take? - correct answer Use arial size 10 font
q q q q q q q q q q q q
A participating blue cross/blue shield (BC/BS) provider receives an explanation of benefits for a patient
q q q q q q q q q q q q q q q
account. The charged amount was $100. BC/BS allowed $80 and applied $40 to the patient's annual
q q q q q q q q q q q q q q q q
deductible. BC/BS paid the balance at 80%. How much should the patient expect to pay? - correct answer $48
q q q q q q q q q q q q q q q q q q
Which of the following indicates a claim should be submitted on paper instead of electronically? - correct
q q q q q q q q q q q q q q q q q
answer The claim requires an attachment
q q q q q
According to HIPAA standards, which of the following identifies the rendering provider on the CMS-1500
q q q q q q q q q q q q q q q
claim form in block 24j? - correct answer NPI
q q q q q q q q
, Which of the following blocks should the billing and coding specialist complete on the CMS-1500 claim form
q q q q q q q q q q q q q q q q q
form for procedures, services or supplies (CPT/HCPCS)? - correct answer Block 24D
q q q q q q q q q q q
Which of the following terms describes when a plan pays 70% of the allowed amount and the patient pays
q q q q q q q q q q q q q q q q q q q
30%? - correct answer Coinsurance
q q q q
A provider charged $500 to claim that had an allowable amount of $400. In which of the following columns
q q q q q q q q q q q q q q q q q q q
should the billing and coding specialist apply the non-allowed charge? - correct answer Adjustment column of
q q q q q q q q q q q q q q q
the credits
q q
Which of the following is a HIPAA compliance guideline affecting electronic health records? - correct answer
q q q q q q q q q q q q q q q q
The electronic transmission and code set standards require every provider to use the healthcare transactions
q q q q q q q q q q q q q q q
,code sets and identifiers q q q
Patient: Jane Austin; Social Security # 555-22-1111; Medicare ID: 555-33-2222A; DOB: 05/22/1945. Claim
q q q q q q q q q q q q q
information entered: Austin, Jane; Social Security #.: 555-22-1111; Medicare ID No.: 555-33-2222A; DOB:
q q q q q q q q q q q q q
052245. Which of the following is a reason this claim was rejected? - correct answer The DOB is entered
q q q q q q q q q q q q q q q q q q q
incorrectly
Why does correct claim processing rely on accurately completed encounter forms? - correct answer They
q q q q q q q q q q q q q q q
streamline patient billing by summarizing the services rendered for a given date of service
q q q q q q q q q q q q q
A patient's health plan is referred to as the "payer of last resort." The patient is covered by which of the
q q q q q q q q q q q q q q q q q q q q q
following health plans? - correct answer Medicaid q q q q q q
Which of the following color formats is acceptable on the CMS-1500 claim form? - correct answer Red
q q q q q q q q q q q q q q q q
Which of the following is an example of a violation of an adult patient's confidentiality? - correct answer
q q q q q q q q q q q q q q q q q q
Patient information was disclosed to the patient's parents without consent.
q q q q q q q q q
In the anesthesia section of the CPT manual, which of the following are considered qualifying circumstances?
q q q q q q q q q q q q q q q q
- correct answer Add-on codes
q q q q
