NHA - Certified Billing and Coding Specialist (CBCS)
Study Guide || QUESTIONS AND CORRECT
ANSWERS; 100% VERIFIED!!
The symbol "O" in the Current Procedural Terminology reference is used to indicate what?
correct answers Reinstated or recycled code
In the anesthesia section of the CPT manual, what are considered qualifying circumstances?
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 action should be taken first when reviewing a delinquent claim? correct answers Verify
the age of the account
A claim can be denied or rejected for which of the following reasons? correct answers Block
24D contains the diagnosis code
A coroner's autopsy is comprised of what examinations? correct answers Gross Examination
Medigap coverage is offered to Medicare beneficiaries by whom? correct answers Private
third-party payers
What part of Medicare covers prescriptions? correct answers Part C
What plane divides the body into left and right? correct answers Sagittal
Where can unlisted codes be found in the CPT manual? correct answers Guidelines prior to
each section
Ambulatory surgery centers, home health care, and hospice organizations use which form to
submit claims? correct answers UB-04 Claim Form
What color format is acceptable on the CMS-1500 claim form? correct answers Red
Who is responsible to pay the deductible? correct answers Patient
A patient's health plan is referred to as the "payer of last resort." What is the name of that
health plan? correct answers Medicaid
Informed Consent correct answers 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 correct answers A patient presents for treatment, such as extending an arm
to allow a venipuncture to be performed.
Clearinghouse correct answers Agency that converts claims into standardized electronic
format, looks for errors, and formats them according to HIPAA and insurance standards.
Individually Identifiable correct answers Documents that identify the person or provide
enough information so that the person can be identified.
De-identified Information correct answers Information that does not identify an individual
because unique and personal characteristics have been removed.
Consent correct answers A patient's permission evidenced by signature.
Authorizations correct answers Permission granted by the patient or the patient's
representative to release information for reasons other than treatment, payment, or health care
operations.
Reimbursement correct answers Payment for services rendered from a third-party payer.
Auditing correct answers Review of claims for accuracy and completeness.
Fraud correct answers Making false statements of representations of material facts to obtain
some benefit or payment for which no entitlement would otherwise exist.
Upcoding correct answers Assigning a diagnosis or procedure code at a higher level than the
documentation supports, such as coding bronchitis as pneumonia.
Unbundling correct answers Using multiple codes that describe different components of a
treatment instead of using a single code that describes all steps of the procedure.
Abuse correct answers Practices that directly or indirectly result in unnecessary costs to the
Medicare program.
Business Associate (BA) correct answers 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)? correct answers The OIG
protects Medicare and other HHS programs from fraud and abuse by conducting audits,
investigations , and inspections.
Medicare correct answers Federally funded health insurance provided to people age 65 or
older, and people 65 and younger with certain disabilities.
Medicaid correct answers A government-based health insurance option that pays for medical
assistance for individuals who have low incomes and limited financial resources.
Timely Filing Requirements correct answers Within 1 calendar year of a claim's date of
service.
Study Guide || QUESTIONS AND CORRECT
ANSWERS; 100% VERIFIED!!
The symbol "O" in the Current Procedural Terminology reference is used to indicate what?
correct answers Reinstated or recycled code
In the anesthesia section of the CPT manual, what are considered qualifying circumstances?
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 action should be taken first when reviewing a delinquent claim? correct answers Verify
the age of the account
A claim can be denied or rejected for which of the following reasons? correct answers Block
24D contains the diagnosis code
A coroner's autopsy is comprised of what examinations? correct answers Gross Examination
Medigap coverage is offered to Medicare beneficiaries by whom? correct answers Private
third-party payers
What part of Medicare covers prescriptions? correct answers Part C
What plane divides the body into left and right? correct answers Sagittal
Where can unlisted codes be found in the CPT manual? correct answers Guidelines prior to
each section
Ambulatory surgery centers, home health care, and hospice organizations use which form to
submit claims? correct answers UB-04 Claim Form
What color format is acceptable on the CMS-1500 claim form? correct answers Red
Who is responsible to pay the deductible? correct answers Patient
A patient's health plan is referred to as the "payer of last resort." What is the name of that
health plan? correct answers Medicaid
Informed Consent correct answers 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 correct answers A patient presents for treatment, such as extending an arm
to allow a venipuncture to be performed.
Clearinghouse correct answers Agency that converts claims into standardized electronic
format, looks for errors, and formats them according to HIPAA and insurance standards.
Individually Identifiable correct answers Documents that identify the person or provide
enough information so that the person can be identified.
De-identified Information correct answers Information that does not identify an individual
because unique and personal characteristics have been removed.
Consent correct answers A patient's permission evidenced by signature.
Authorizations correct answers Permission granted by the patient or the patient's
representative to release information for reasons other than treatment, payment, or health care
operations.
Reimbursement correct answers Payment for services rendered from a third-party payer.
Auditing correct answers Review of claims for accuracy and completeness.
Fraud correct answers Making false statements of representations of material facts to obtain
some benefit or payment for which no entitlement would otherwise exist.
Upcoding correct answers Assigning a diagnosis or procedure code at a higher level than the
documentation supports, such as coding bronchitis as pneumonia.
Unbundling correct answers Using multiple codes that describe different components of a
treatment instead of using a single code that describes all steps of the procedure.
Abuse correct answers Practices that directly or indirectly result in unnecessary costs to the
Medicare program.
Business Associate (BA) correct answers 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)? correct answers The OIG
protects Medicare and other HHS programs from fraud and abuse by conducting audits,
investigations , and inspections.
Medicare correct answers Federally funded health insurance provided to people age 65 or
older, and people 65 and younger with certain disabilities.
Medicaid correct answers A government-based health insurance option that pays for medical
assistance for individuals who have low incomes and limited financial resources.
Timely Filing Requirements correct answers Within 1 calendar year of a claim's date of
service.
