NHA - Certified Billing and Coding
Specialist (CBCS) Study Guide 2025
With 100% Correct Answers
What does the symbol 'O' in the Current Procedural Terminology reference indicate? - correct answers
✔✔Reinstated or recycled code
What are considered qualifying circumstances in the anesthesia section of the CPT manual? - correct
answers ✔✔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? - correct answers ✔✔12
What is considered proper supportive documentation for reporting CPT and ICD codes for surgical
procedures? - correct answers ✔✔Operative report
What is the first action to take when reviewing a delinquent claim? - correct answers ✔✔Verify the age
of the account
For which of the following reasons can a claim be denied or rejected? - correct answers ✔✔Block 24D
contains the diagnosis code
What examinations are comprised in a coroner's autopsy? - correct answers ✔✔Gross Examination
Who offers Medigap coverage to Medicare beneficiaries? - correct answers ✔✔Private third-party payers
Which part of Medicare covers prescriptions? - correct answers ✔✔Part D
Which plane divides the body into left and right? - correct answers ✔✔Sagittal
, Where are unlisted codes located in the CPT manual? - correct answers ✔✔Guidelines prior to each
section
What form do ambulatory surgery centers, home health care, and hospice organizations use to submit
claims? - correct answers ✔✔UB-04 Claim Form
What color format is accepted on the CMS-1500 claim form? - correct answers ✔✔Red
Who is responsible for paying the deductible? - correct answers ✔✔Patient
What is the patient's health plan referred to as the 'payer of last resort'? - correct answers ✔✔Medicaid
Definition: Informed Consent - correct answers ✔✔Providers explain medical procedures, surgical
interventions, benefits, and risks to patients before intervention.
Definition: Implied Consent - correct answers ✔✔Patient's actions imply consent for treatment, e.g.,
extending an arm for venipuncture.
What is the role of a Clearinghouse in medical billing? - correct answers ✔✔Converts claims to electronic
format, checks for errors, and ensures compliance with HIPAA and insurance standards.
What does 'Individually Identifiable' mean in healthcare documentation? - correct answers
✔✔Information that can identify a person or provide enough details for identification.
What is 'De-identified Information' in healthcare? - correct answers ✔✔Information with personal
characteristics removed, making it unable to identify an individual.
Consent - correct answers ✔✔A patient's permission evidenced by signature.
Authorizations - correct answers ✔✔Permission granted by the patient or the patient's representative
for purposes other than treatment, payment, or health care operations.
Specialist (CBCS) Study Guide 2025
With 100% Correct Answers
What does the symbol 'O' in the Current Procedural Terminology reference indicate? - correct answers
✔✔Reinstated or recycled code
What are considered qualifying circumstances in the anesthesia section of the CPT manual? - correct
answers ✔✔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? - correct answers ✔✔12
What is considered proper supportive documentation for reporting CPT and ICD codes for surgical
procedures? - correct answers ✔✔Operative report
What is the first action to take when reviewing a delinquent claim? - correct answers ✔✔Verify the age
of the account
For which of the following reasons can a claim be denied or rejected? - correct answers ✔✔Block 24D
contains the diagnosis code
What examinations are comprised in a coroner's autopsy? - correct answers ✔✔Gross Examination
Who offers Medigap coverage to Medicare beneficiaries? - correct answers ✔✔Private third-party payers
Which part of Medicare covers prescriptions? - correct answers ✔✔Part D
Which plane divides the body into left and right? - correct answers ✔✔Sagittal
, Where are unlisted codes located in the CPT manual? - correct answers ✔✔Guidelines prior to each
section
What form do ambulatory surgery centers, home health care, and hospice organizations use to submit
claims? - correct answers ✔✔UB-04 Claim Form
What color format is accepted on the CMS-1500 claim form? - correct answers ✔✔Red
Who is responsible for paying the deductible? - correct answers ✔✔Patient
What is the patient's health plan referred to as the 'payer of last resort'? - correct answers ✔✔Medicaid
Definition: Informed Consent - correct answers ✔✔Providers explain medical procedures, surgical
interventions, benefits, and risks to patients before intervention.
Definition: Implied Consent - correct answers ✔✔Patient's actions imply consent for treatment, e.g.,
extending an arm for venipuncture.
What is the role of a Clearinghouse in medical billing? - correct answers ✔✔Converts claims to electronic
format, checks for errors, and ensures compliance with HIPAA and insurance standards.
What does 'Individually Identifiable' mean in healthcare documentation? - correct answers
✔✔Information that can identify a person or provide enough details for identification.
What is 'De-identified Information' in healthcare? - correct answers ✔✔Information with personal
characteristics removed, making it unable to identify an individual.
Consent - correct answers ✔✔A patient's permission evidenced by signature.
Authorizations - correct answers ✔✔Permission granted by the patient or the patient's representative
for purposes other than treatment, payment, or health care operations.
