NHA - Certified Billing and Coding Specialist (CBCS) Study Guide
QUESTIONS WITH WELL VERIFIED ANSWERS
What does the symbol 'O' in the Current Procedural Terminology reference indicate? -
answer☑️✔️..Reinstated or recycled code
What are considered qualifying circumstances in the anesthesia section of the CPT manual? -
answer☑️✔️..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? - answer☑️✔️..12
What is considered proper supportive documentation for reporting CPT and ICD codes for
surgical procedures? - answer☑️✔️..Operative report
What is the first action to take when reviewing a delinquent claim? - answer☑️✔️..Verify the
age of the account
For which of the following reasons can a claim be denied or rejected? - answer☑️✔️..Block
24D contains the diagnosis code
What examinations are comprised in a coroner's autopsy? - answer☑️✔️..Gross Examination
Who offers Medigap coverage to Medicare beneficiaries? - answer☑️✔️..Private third-party
payers
Which part of Medicare covers prescriptions? - answer☑️✔️..Part D
,Which plane divides the body into left and right? - answer☑️✔️..Sagittal
Where are unlisted codes located in the CPT manual? - answer☑️✔️..Guidelines prior to each
section
What form do ambulatory surgery centers, home health care, and hospice organizations use to
submit claims? - answer☑️✔️..UB-04 Claim Form
What color format is accepted on the CMS-1500 claim form? - answer☑️✔️..Red
Who is responsible for paying the deductible? - answer☑️✔️..Patient
What is the patient's health plan referred to as the 'payer of last resort'? -
answer☑️✔️..Medicaid
Definition: Informed Consent - answer☑️✔️..Providers explain medical procedures, surgical
interventions, benefits, and risks to patients before intervention.
Definition: Implied Consent - answer☑️✔️..Patient's actions imply consent for treatment, e.g.,
extending an arm for venipuncture.
What is the role of a Clearinghouse in medical billing? - answer☑️✔️..Converts claims to
electronic format, checks for errors, and ensures compliance with HIPAA and insurance
standards.
What does 'Individually Identifiable' mean in healthcare documentation? -
answer☑️✔️..Information that can identify a person or provide enough details for
identification.
, What is 'De-identified Information' in healthcare? - answer☑️✔️..Information with personal
characteristics removed, making it unable to identify an individual.
Consent - answer☑️✔️..A patient's permission evidenced by signature.
Authorizations - answer☑️✔️..Permission granted by the patient or the patient's
representative for purposes other than treatment, payment, or health care operations.
Reimbursement - answer☑️✔️..Payment for services provided by a third-party payer.
Auditing - answer☑️✔️..Reviewing claims for accuracy and completeness.
Fraud - answer☑️✔️..Making false statements to obtain undeserved benefits or payments.
Upcoding - answer☑️✔️..Assigning a higher-level code than supported by documentation, like
coding bronchitis as pneumonia.
Unbundling - answer☑️✔️..Using multiple codes for separate treatment components instead
of a single comprehensive code.
Abuse - answer☑️✔️..Practices leading to unnecessary costs for Medicare.
Business Associate (BA) - answer☑️✔️..Individuals or organizations outside a covered entity's
workforce performing functions for the entity.
QUESTIONS WITH WELL VERIFIED ANSWERS
What does the symbol 'O' in the Current Procedural Terminology reference indicate? -
answer☑️✔️..Reinstated or recycled code
What are considered qualifying circumstances in the anesthesia section of the CPT manual? -
answer☑️✔️..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? - answer☑️✔️..12
What is considered proper supportive documentation for reporting CPT and ICD codes for
surgical procedures? - answer☑️✔️..Operative report
What is the first action to take when reviewing a delinquent claim? - answer☑️✔️..Verify the
age of the account
For which of the following reasons can a claim be denied or rejected? - answer☑️✔️..Block
24D contains the diagnosis code
What examinations are comprised in a coroner's autopsy? - answer☑️✔️..Gross Examination
Who offers Medigap coverage to Medicare beneficiaries? - answer☑️✔️..Private third-party
payers
Which part of Medicare covers prescriptions? - answer☑️✔️..Part D
,Which plane divides the body into left and right? - answer☑️✔️..Sagittal
Where are unlisted codes located in the CPT manual? - answer☑️✔️..Guidelines prior to each
section
What form do ambulatory surgery centers, home health care, and hospice organizations use to
submit claims? - answer☑️✔️..UB-04 Claim Form
What color format is accepted on the CMS-1500 claim form? - answer☑️✔️..Red
Who is responsible for paying the deductible? - answer☑️✔️..Patient
What is the patient's health plan referred to as the 'payer of last resort'? -
answer☑️✔️..Medicaid
Definition: Informed Consent - answer☑️✔️..Providers explain medical procedures, surgical
interventions, benefits, and risks to patients before intervention.
Definition: Implied Consent - answer☑️✔️..Patient's actions imply consent for treatment, e.g.,
extending an arm for venipuncture.
What is the role of a Clearinghouse in medical billing? - answer☑️✔️..Converts claims to
electronic format, checks for errors, and ensures compliance with HIPAA and insurance
standards.
What does 'Individually Identifiable' mean in healthcare documentation? -
answer☑️✔️..Information that can identify a person or provide enough details for
identification.
, What is 'De-identified Information' in healthcare? - answer☑️✔️..Information with personal
characteristics removed, making it unable to identify an individual.
Consent - answer☑️✔️..A patient's permission evidenced by signature.
Authorizations - answer☑️✔️..Permission granted by the patient or the patient's
representative for purposes other than treatment, payment, or health care operations.
Reimbursement - answer☑️✔️..Payment for services provided by a third-party payer.
Auditing - answer☑️✔️..Reviewing claims for accuracy and completeness.
Fraud - answer☑️✔️..Making false statements to obtain undeserved benefits or payments.
Upcoding - answer☑️✔️..Assigning a higher-level code than supported by documentation, like
coding bronchitis as pneumonia.
Unbundling - answer☑️✔️..Using multiple codes for separate treatment components instead
of a single comprehensive code.
Abuse - answer☑️✔️..Practices leading to unnecessary costs for Medicare.
Business Associate (BA) - answer☑️✔️..Individuals or organizations outside a covered entity's
workforce performing functions for the entity.
