NHA CBCS EXAM STUDY GUIDE Tested Questions with Verified Answers Grade A+ Guarantee

NHA CBCS EXAM STUDY GUIDE
Tested Questions with Verified Answers
Grade A+ Guarantee




1. Medical Billing & Coding as a Career: *Claims assistant professional or claims manag
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er, *Coding Specialist, * Collection Manager, *Electronic Claims Processor,
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*Insurance Billing Specialist, * Insurance Coordinator, *Insurance Counselor, *Med- ical Biller,
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*Medical & Financial Records Manager, * Billing & Coding Specialist
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2. What are Medical Ethics?: Standards of conduct based on moral principle.They are generally accept
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ed as a guide for behavior towards pt's, dr's, co-workers, the gov, and ins co's.
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,3. What does acting within ethical behavior boundaries mean?: carrying out one's resp
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onsibilities w/ integrity, dignity, respect, honesty, competence, fairness, & trust.
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4. Compliance regulations:: Most billing-related cases are based on HIPPA and False Claims Act
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5. Health Insurance Portability & Accountability Act (HIPPA): Enacted in 1996, created by th
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e Health Care Fraud & Abuse Control Program-
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enacted to check for fraud and abuse in the Medicare/Medicaid Programs and private payers
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6. What are the 2 provisions of HIPPA?: Title I: Insurance Reform Title II: Admi
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nistrative Simplification
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,7. What is Title I of HIPPA?: Insurance Reform-primary purpose is to provide con-
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tinuous ins coverage for worker & their dependents when they change or lose jobs. Also *Limits the use
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of preexisting conditions exclusions *Prohibits discrimination from past or present poor health
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*Guarantees certain employees/indv the right to purchase new health ins coverage after losing job
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*Allows renewal of health ins cov regardless of an indv's health cond. that is covered under the particular polic
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8. What is Title II of HIPPA?: Administrative Simplification-
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goal is to focus on the health care practice setting to reduce administrative cost & burdens. Has 2 parts-
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1) development and implementation of standardized health-related financial & admin-
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istrative activities electronically 2) Implementation of privacy & security procedures to prevent the misuse
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of health info by ensuring confidentiality
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, 9. What is the False Claims Act (FCA)?: Federal law that prohibits submitting a fraudulent claim o
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r making a false statement or representation in connection w/ a claim. Also protects & rewards whistle
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-blowers.




10. What is the National Correct Coding Initiative (NCCI)?: Developed by CMS to promot
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e the national correct coding methodologies & to control improper coding that lead to inappropriate
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payment of Part B health ins claims.
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11. How many edits does NCCI include?: 2: 1)Column 1/Column 2 (prev called Co
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2) Mutually Exclusive Edits
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