1 | Page
NHA 2024-2025 CBCS Practice Questions
(Set 1): Questions and Answers 2026 Latest
Update
What is the first step in verifying a patient's insurance
information? Ans: Review the patient's insurnace card for policy
number and group number
What is the most crucial step in verifying a patient's insurance
information before providing medical services? Ans: Verifying a
patients eligibility and benefits directly with the insurance
company
Which of the following is a primary characteristic of workers'
compensation plans? Ans: They cover medical expenses and lost
wages due to work related injuries
What is the primary step a medical billing and coding specialist
should take when a claim is denied by a third party payer? Ans:
Review the Explanation of benefits (EOB) to determine the reason
for denial
When filling a claim with multiple insurance carriers, which
insurance should be billed first? Ans: The primary insurance of
the patient
When coding from an operative report, which section typically
contains the most detailed description of surgical procedure
performed? Ans: Operative note
© 2025 All rights reserved
, 2 | Page
What is the primary purpose of the explanation of benefits (EOB)
document in the revenue cycle management process? Ans: To
outline the patient's payment responsibilities and the payer's
payment decisions
Dr. Smith's clinic has recently implemented a compliance plan to
ensure adherence regulatory standards. During an internal audit, it
was discovered that an overpayment was received from Medicare
for services rendered to a patient named John Doe.
According to the Provider Self-Disclosure Protocol (SDP), what is
the appropriate action Dr. Smith's clinic should take? Ans: Report
the overpayment to Medicare within 60 days
Sarah a medical billing and coding specialist is reviewing a claim
that was denied by a third-party payer due-to "lack of medical
necessity." Which of the following actions should Sarah take to
address this denial? Ans: Appeal the denial with supporting
documentation from the patient's medical record
John, a 45 year-old employee at a manufacturing company is
reviewing this employee-sponsored health insurance options. He
notices that one of the plans is a Preferred Provider Organization
(PPO) while another is a Health Maintenance Organization (HMO).
John values having the flexibility to see specialists without needing
a referral. Which plan should choose to best meet his needs? Ans:
Preferred Provider Organization (PPO)
During the pre-authorization process for a complex surgical
procedure, the insurance company request additional
documentation or verify medical necessity. As the medical billing
specialists, how should you clearly and accurately communicate
this requirement to Dr. Smith, the surgeon, to ensure timely
© 2025 All rights reserved
, 3 | Page
compliance? Ans: Schedule a meeting with Dr. Smith to discuss the
specific documents required and their importance.
Doctor Smith submitted a claim for a patient named John Doe,
who under went a minor surgical procedure. The claim was denied
due to a code edit indicating a bundling issue. What should the
medical biller do first to resolve this issue? Ans: Review the
National Correct Coding Initiative (NCCI) Edits
John a patient is undergoing treatment for a chronic condition.
During the visit, the healthcare provider discusses the importance
of accurately documenting his treatment plan and communicating
it with the billing department to ensure proper coding and
reimbursement. Which of the following steps is most crucial in
maintaining regulatory compliance and ensuring accurate
communication with stakeholders throughout the revenue cycle?
Ans: Verifying that all treatment codes are entered correctly into
the Electronic Health Record (EHR).
What is the purpose of Local Coverage Determination (LCD) in the
context of medical billing and reimbursement? Ans: To define
specific coverage criteria for services at the local level
When is it important to issue an Advanced Beneficiary Notice
(ABN) to a Medicare patient? Ans: When the provider believes
Medicare will likely deny payment for a service
What is the primary limitation of Medicare Part B coverage for out
patient services? Ans: It requires beneficiaries to pay an annual
deductible and 20% coinsurance for most services
Doctor Smith administered general anesthesia to a 45 year old
patient, John Doe, for a complex abdominal surgery that lasted 3
© 2025 All rights reserved
NHA 2024-2025 CBCS Practice Questions
(Set 1): Questions and Answers 2026 Latest
Update
What is the first step in verifying a patient's insurance
information? Ans: Review the patient's insurnace card for policy
number and group number
What is the most crucial step in verifying a patient's insurance
information before providing medical services? Ans: Verifying a
patients eligibility and benefits directly with the insurance
company
Which of the following is a primary characteristic of workers'
compensation plans? Ans: They cover medical expenses and lost
wages due to work related injuries
What is the primary step a medical billing and coding specialist
should take when a claim is denied by a third party payer? Ans:
Review the Explanation of benefits (EOB) to determine the reason
for denial
When filling a claim with multiple insurance carriers, which
insurance should be billed first? Ans: The primary insurance of
the patient
When coding from an operative report, which section typically
contains the most detailed description of surgical procedure
performed? Ans: Operative note
© 2025 All rights reserved
, 2 | Page
What is the primary purpose of the explanation of benefits (EOB)
document in the revenue cycle management process? Ans: To
outline the patient's payment responsibilities and the payer's
payment decisions
Dr. Smith's clinic has recently implemented a compliance plan to
ensure adherence regulatory standards. During an internal audit, it
was discovered that an overpayment was received from Medicare
for services rendered to a patient named John Doe.
According to the Provider Self-Disclosure Protocol (SDP), what is
the appropriate action Dr. Smith's clinic should take? Ans: Report
the overpayment to Medicare within 60 days
Sarah a medical billing and coding specialist is reviewing a claim
that was denied by a third-party payer due-to "lack of medical
necessity." Which of the following actions should Sarah take to
address this denial? Ans: Appeal the denial with supporting
documentation from the patient's medical record
John, a 45 year-old employee at a manufacturing company is
reviewing this employee-sponsored health insurance options. He
notices that one of the plans is a Preferred Provider Organization
(PPO) while another is a Health Maintenance Organization (HMO).
John values having the flexibility to see specialists without needing
a referral. Which plan should choose to best meet his needs? Ans:
Preferred Provider Organization (PPO)
During the pre-authorization process for a complex surgical
procedure, the insurance company request additional
documentation or verify medical necessity. As the medical billing
specialists, how should you clearly and accurately communicate
this requirement to Dr. Smith, the surgeon, to ensure timely
© 2025 All rights reserved
, 3 | Page
compliance? Ans: Schedule a meeting with Dr. Smith to discuss the
specific documents required and their importance.
Doctor Smith submitted a claim for a patient named John Doe,
who under went a minor surgical procedure. The claim was denied
due to a code edit indicating a bundling issue. What should the
medical biller do first to resolve this issue? Ans: Review the
National Correct Coding Initiative (NCCI) Edits
John a patient is undergoing treatment for a chronic condition.
During the visit, the healthcare provider discusses the importance
of accurately documenting his treatment plan and communicating
it with the billing department to ensure proper coding and
reimbursement. Which of the following steps is most crucial in
maintaining regulatory compliance and ensuring accurate
communication with stakeholders throughout the revenue cycle?
Ans: Verifying that all treatment codes are entered correctly into
the Electronic Health Record (EHR).
What is the purpose of Local Coverage Determination (LCD) in the
context of medical billing and reimbursement? Ans: To define
specific coverage criteria for services at the local level
When is it important to issue an Advanced Beneficiary Notice
(ABN) to a Medicare patient? Ans: When the provider believes
Medicare will likely deny payment for a service
What is the primary limitation of Medicare Part B coverage for out
patient services? Ans: It requires beneficiaries to pay an annual
deductible and 20% coinsurance for most services
Doctor Smith administered general anesthesia to a 45 year old
patient, John Doe, for a complex abdominal surgery that lasted 3
© 2025 All rights reserved
