NHA CBCS EXAM REVIEW EXAM STUDY GUIDE
2026 COMPLETE QUESTIONS AND ANSWERS
◉ Which of the following statements is accurate regarding the
diagnostic codes in Block 21? Answer: These codes must correspond
to the diagnosis pointer in Block 24E
◉ Which of the following parts of the Medicare insurance program is
managed by private, third-party insurance providers that have been
approved by Medicare? Answer: Medicare Part C
◉ A billing and coding specialist can ensure appropriate insurance
coverage for an outpatient procedure by first using which of the
following processes? Answer: Precertification
**Precertification is the first step. Preauthorization is a decision
from the payer to approve the service. It is not the first step to
determine insurance reimbursement.
◉ Which of the following is considered fraud? Answer: The billing
and coding specialist unbundles a code to receive higher
reimbursement
,◉ The authorization number for a service that was approved before
the service was rendered is indicated in which of the following
blocks on the CMS-1500 claim form? Answer: Block 23
◉ A patient is preauthorized to receive vitamin B12 injections from
Jan 1 to May 31. On June 2, the provider orders an additional 6
months of injections. In order for the patient to continue with
coverage of care, which of the following should occur? Answer: The
provider should contact the patient's insurance carrier to obtain a
new authorization
◉ Which of the following symbols indicates a revised code? Answer:
Triangle
◉ If both parents have full coverage for a dependent child, which of
the following is considered to be the primary insurance holder?
Answer: The parent whose birthdate comes first in the calendar year
is the primary insurance holder
◉ Which of the following entities defines the essential elements of a
comprehensive compliance program? Answer: Office of Inspector
General (OIG)
◉ The >< symbol is used to indicate new and revised text other than
which of the following? Answer: Procedure descriptors
,◉ Which of the following describes the organization of an aging
report? Answer: By date
◉ Which of the following is the purpose of coordination of benefits?
Answer: Prevent multiple insurers from paying benefits covered by
other policies
◉ A billing and coding specialist submitted a claim to Medicare
electronically. No errors were found by the billing software or
clearinghouse. Which of the following describes this claim? Answer:
Clean claim
◉ Which of the following qualifies as an exception to the HIPAA
Privacy Rule? Answer: Psychotherapy notes
◉ Which of the following would result in a claim being denied?
Answer: An italicized code used as the first listed diagnosis
◉ Which of the following standardized formats are used in the
electronic filing of claims? Answer: HIPAA standard transactions
◉ Which of the following describes a two-digit CPT code used to
indicate that the provider supervised an interpreted a radiology
procedure? Answer: Professional component
, ◉ Which of the following formats are used to submit electronic
claims to a third-party payer? Answer: 837
◉ Urine moved from the kidneys to the bladder through which of
the following parts of the body? Answer: Ureters
◉ 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? Answer: 12
◉ Which of the following does a patient sign to allow payment of
claims directly to the provider? Answer: Assignment of benefits
◉ Which of the following is the primary function of the heart?
Answer: Pumping blood in the circulatory system
◉ Which of the following is true regarding Medicaid eligibility?
Answer: Patient eligibility is determined monthly
◉ The explanation of benefits states the amount billed was $80. The
allowed amount is $60, and the patient is required to pay a $20
copayment. Which of the following describes the insurance check
amount to be posted? Answer: $40
2026 COMPLETE QUESTIONS AND ANSWERS
◉ Which of the following statements is accurate regarding the
diagnostic codes in Block 21? Answer: These codes must correspond
to the diagnosis pointer in Block 24E
◉ Which of the following parts of the Medicare insurance program is
managed by private, third-party insurance providers that have been
approved by Medicare? Answer: Medicare Part C
◉ A billing and coding specialist can ensure appropriate insurance
coverage for an outpatient procedure by first using which of the
following processes? Answer: Precertification
**Precertification is the first step. Preauthorization is a decision
from the payer to approve the service. It is not the first step to
determine insurance reimbursement.
◉ Which of the following is considered fraud? Answer: The billing
and coding specialist unbundles a code to receive higher
reimbursement
,◉ The authorization number for a service that was approved before
the service was rendered is indicated in which of the following
blocks on the CMS-1500 claim form? Answer: Block 23
◉ A patient is preauthorized to receive vitamin B12 injections from
Jan 1 to May 31. On June 2, the provider orders an additional 6
months of injections. In order for the patient to continue with
coverage of care, which of the following should occur? Answer: The
provider should contact the patient's insurance carrier to obtain a
new authorization
◉ Which of the following symbols indicates a revised code? Answer:
Triangle
◉ If both parents have full coverage for a dependent child, which of
the following is considered to be the primary insurance holder?
Answer: The parent whose birthdate comes first in the calendar year
is the primary insurance holder
◉ Which of the following entities defines the essential elements of a
comprehensive compliance program? Answer: Office of Inspector
General (OIG)
◉ The >< symbol is used to indicate new and revised text other than
which of the following? Answer: Procedure descriptors
,◉ Which of the following describes the organization of an aging
report? Answer: By date
◉ Which of the following is the purpose of coordination of benefits?
Answer: Prevent multiple insurers from paying benefits covered by
other policies
◉ A billing and coding specialist submitted a claim to Medicare
electronically. No errors were found by the billing software or
clearinghouse. Which of the following describes this claim? Answer:
Clean claim
◉ Which of the following qualifies as an exception to the HIPAA
Privacy Rule? Answer: Psychotherapy notes
◉ Which of the following would result in a claim being denied?
Answer: An italicized code used as the first listed diagnosis
◉ Which of the following standardized formats are used in the
electronic filing of claims? Answer: HIPAA standard transactions
◉ Which of the following describes a two-digit CPT code used to
indicate that the provider supervised an interpreted a radiology
procedure? Answer: Professional component
, ◉ Which of the following formats are used to submit electronic
claims to a third-party payer? Answer: 837
◉ Urine moved from the kidneys to the bladder through which of
the following parts of the body? Answer: Ureters
◉ 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? Answer: 12
◉ Which of the following does a patient sign to allow payment of
claims directly to the provider? Answer: Assignment of benefits
◉ Which of the following is the primary function of the heart?
Answer: Pumping blood in the circulatory system
◉ Which of the following is true regarding Medicaid eligibility?
Answer: Patient eligibility is determined monthly
◉ The explanation of benefits states the amount billed was $80. The
allowed amount is $60, and the patient is required to pay a $20
copayment. Which of the following describes the insurance check
amount to be posted? Answer: $40
