NHA CBCS Final Exam – National Healthcareer
Association – 2026/2027 Edition – Questions and
Answers for Medical Billing and Coding Students
SECTION I: THE REVENUE CYCLE AND REGULATORY COMPLIANCE
1. The process of collecting patient demographics, insurance information, and
obtaining necessary authorizations before a patient receives services is known
as:
• A) Claims adjudication
• B) Pre-registration
• C) Medical necessity review
• D) Accounts receivable management
Correct Answer: B
Rationale: Pre-registration is the first step in the revenue cycle, involving the
collection of patient information, insurance verification, and authorization before
services are rendered. Claims adjudication occurs after submission, medical
necessity review evaluates whether services are medically necessary, and accounts
receivable management tracks unpaid claims.
2. Under HIPAA, protected health information (PHI) includes all of the following
EXCEPT:
• A) Patient's name and date of birth
• B) Social Security number
• C) Patient's medical record number
• D) De-identified data used for research
,Correct Answer: D
Rationale: De-identified data—from which all 18 HIPAA identifiers have been
removed—is no longer considered PHI and is not protected under the Privacy Rule.
All other options are identifiers that constitute PHI.
3. Which federal law establishes the standards for electronic healthcare
transactions and code sets?
• A) HIPAA Administrative Simplification Act
• B) False Claims Act
• C) Stark Law
• D) Anti-Kickback Statute
Correct Answer: A
Rationale: HIPAA's Administrative Simplification provisions mandate standard
electronic transactions, code sets, and unique health identifiers to improve
efficiency in healthcare data exchange. The False Claims Act addresses fraud, Stark
Law addresses physician self-referral, and the Anti-Kickback Statute prohibits
remuneration for referrals.
4. A physician practices in a rural area and refers a patient to a lab that is owned
by the physician's spouse. This scenario may implicate which law?
• A) HIPAA Privacy Rule
• B) Stark Law
• C) Emergency Medical Treatment and Labor Act (EMTALA)
• D) Clinical Laboratory Improvement Amendments (CLIA)
Correct Answer: B
Rationale: Stark Law prohibits physicians from referring Medicare patients for
designated health services to entities with which the physician has a financial
,relationship, unless an exception applies. This scenario involves a financial
relationship (spouse ownership) and a designated health service (lab services).
5. Which of the following is a characteristic of a "clean claim"?
• A) It contains all required data elements and passes all edits
• B) It has been appealed twice
• C) It is submitted on paper only
• D) It contains estimated charges
Correct Answer: A
Rationale: A clean claim contains all necessary information and passes all payer
edits without errors. Clean claims are processed faster and have lower denial
rates. Clean claims can be electronic or paper.
6. The false claims act prohibits:
• A) Billing for services not rendered
• B) Upcoding services
• C) Double billing
• D) All of the above
Correct Answer: D
Rationale: The False Claims Act prohibits knowingly presenting false claims for
payment. This includes billing for services not rendered, upcoding (billing a higher-
level code than warranted), unbundling, and double billing. Violations can result in
significant penalties.
7. The process of reviewing claims for errors before submission to the payer is
called:
, • A) Claims scrubbing
• B) Claims adjudication
• C) Claims reprocessing
• D) Claims reconciliation
Correct Answer: A
Rationale: Claims scrubbing is the process of checking claims for errors, missing
information, and compliance issues before submission to reduce denials and
improve first-pass acceptance rates. Adjudication occurs after the payer receives
the claim.
8. The HIPAA Privacy Rule requires covered entities to provide patients with:
• A) A notice of privacy practices
• B) Access to their medical records
• C) An accounting of disclosures
• D) All of the above
Correct Answer: D
Rationale: The HIPAA Privacy Rule grants patients rights to receive a Notice of
Privacy Practices, access their protected health information, request amendments,
and receive an accounting of certain disclosures of their PHI.
9. Which of the following is NOT an element of compliance with Medicare's
documentation requirements?
• A) Medical necessity must be documented
• B) Services must be accurately coded
• C) A copy of the patient's insurance card must be included
• D) Documentation must support the level of service billed
Association – 2026/2027 Edition – Questions and
Answers for Medical Billing and Coding Students
SECTION I: THE REVENUE CYCLE AND REGULATORY COMPLIANCE
1. The process of collecting patient demographics, insurance information, and
obtaining necessary authorizations before a patient receives services is known
as:
• A) Claims adjudication
• B) Pre-registration
• C) Medical necessity review
• D) Accounts receivable management
Correct Answer: B
Rationale: Pre-registration is the first step in the revenue cycle, involving the
collection of patient information, insurance verification, and authorization before
services are rendered. Claims adjudication occurs after submission, medical
necessity review evaluates whether services are medically necessary, and accounts
receivable management tracks unpaid claims.
2. Under HIPAA, protected health information (PHI) includes all of the following
EXCEPT:
• A) Patient's name and date of birth
• B) Social Security number
• C) Patient's medical record number
• D) De-identified data used for research
,Correct Answer: D
Rationale: De-identified data—from which all 18 HIPAA identifiers have been
removed—is no longer considered PHI and is not protected under the Privacy Rule.
All other options are identifiers that constitute PHI.
3. Which federal law establishes the standards for electronic healthcare
transactions and code sets?
• A) HIPAA Administrative Simplification Act
• B) False Claims Act
• C) Stark Law
• D) Anti-Kickback Statute
Correct Answer: A
Rationale: HIPAA's Administrative Simplification provisions mandate standard
electronic transactions, code sets, and unique health identifiers to improve
efficiency in healthcare data exchange. The False Claims Act addresses fraud, Stark
Law addresses physician self-referral, and the Anti-Kickback Statute prohibits
remuneration for referrals.
4. A physician practices in a rural area and refers a patient to a lab that is owned
by the physician's spouse. This scenario may implicate which law?
• A) HIPAA Privacy Rule
• B) Stark Law
• C) Emergency Medical Treatment and Labor Act (EMTALA)
• D) Clinical Laboratory Improvement Amendments (CLIA)
Correct Answer: B
Rationale: Stark Law prohibits physicians from referring Medicare patients for
designated health services to entities with which the physician has a financial
,relationship, unless an exception applies. This scenario involves a financial
relationship (spouse ownership) and a designated health service (lab services).
5. Which of the following is a characteristic of a "clean claim"?
• A) It contains all required data elements and passes all edits
• B) It has been appealed twice
• C) It is submitted on paper only
• D) It contains estimated charges
Correct Answer: A
Rationale: A clean claim contains all necessary information and passes all payer
edits without errors. Clean claims are processed faster and have lower denial
rates. Clean claims can be electronic or paper.
6. The false claims act prohibits:
• A) Billing for services not rendered
• B) Upcoding services
• C) Double billing
• D) All of the above
Correct Answer: D
Rationale: The False Claims Act prohibits knowingly presenting false claims for
payment. This includes billing for services not rendered, upcoding (billing a higher-
level code than warranted), unbundling, and double billing. Violations can result in
significant penalties.
7. The process of reviewing claims for errors before submission to the payer is
called:
, • A) Claims scrubbing
• B) Claims adjudication
• C) Claims reprocessing
• D) Claims reconciliation
Correct Answer: A
Rationale: Claims scrubbing is the process of checking claims for errors, missing
information, and compliance issues before submission to reduce denials and
improve first-pass acceptance rates. Adjudication occurs after the payer receives
the claim.
8. The HIPAA Privacy Rule requires covered entities to provide patients with:
• A) A notice of privacy practices
• B) Access to their medical records
• C) An accounting of disclosures
• D) All of the above
Correct Answer: D
Rationale: The HIPAA Privacy Rule grants patients rights to receive a Notice of
Privacy Practices, access their protected health information, request amendments,
and receive an accounting of certain disclosures of their PHI.
9. Which of the following is NOT an element of compliance with Medicare's
documentation requirements?
• A) Medical necessity must be documented
• B) Services must be accurately coded
• C) A copy of the patient's insurance card must be included
• D) Documentation must support the level of service billed
