NHA CBCS CERTIFICATION ACTUAL EXAM VERSION A
NEWEST VERSION 2026 ACTUAL EXAM 103 + QUESTIONS AND
CORRECT DETAILED ANSWERS (VERIFIED ANSWERS)
|ALREADY GRADED A+.
QUESTION
In the context of insurance claims processing, which of the following terms refers to the
final determination made regarding the settlement of an insurance claim after it has
undergone a series of reviews and edits?
A. Adjudication
B. Reconciliation
C. Verification
D. Authorization
CORRECT ANS: A
Expert Rationale
Adjudication is the comprehensive process by which an insurance claim is reviewed,
evaluated, and a final determination is made regarding payment. This process involves a
series of automated and manual edits that check for errors, verify coverage, and apply
the patient's benefits. The outcome of adjudication is the determination of the amount
the insurance company will pay, the amount the patient owes, and any adjustments to
be made. Options B, C, and D are incorrect; reconciliation is the process of matching
payments to claims, verification is the process of confirming coverage, and authorization
is the process of obtaining approval for services.
QUESTION
A form that contains charges, dates of service (DOS), CPT codes, fees, and copayment
information is called which of the following?
A. Encounter form
B. Superbill
,C. Remittance advice
D. Explanation of benefits
CORRECT ANS: A
Expert Rationale
An encounter form (also known as a superbill) is a document used in a medical office to
record the services provided to a patient during a single visit. It typically includes the
date of service, the CPT and ICD codes for the services rendered, the fees charged, and
the patient's copayment information. This form serves as a source document for billing
and coding. Option B is a synonym for an encounter form, but A is the standard term.
Option C is incorrect; a remittance advice is a statement sent by the payer to the
provider. Option D is incorrect; an explanation of benefits is a statement sent to the
patient or provider explaining the payment decision.
QUESTION
A patient is admitted to the hospital for an inpatient procedure. Which of the following
hospital staff members is primarily responsible for the initial patient interview, obtaining
demographic and insurance information, and documenting the chief complaint?
A. Admitting clerk
B. Billing specialist
C. Registered nurse
D. Patient access representative
CORRECT ANS: A
Expert Rationale
The admitting clerk (or patient access representative) is responsible for the initial
registration of a patient upon admission to the hospital. This role involves conducting
the initial patient interview, collecting demographic and insurance information, verifying
eligibility, and documenting the reason for the visit (chief complaint) in the patient's
record. This process is crucial for ensuring accurate billing and reimbursement. Options
B, C, and D are incorrect; while they may have roles in patient care or billing, the
admitting clerk performs the specific duties described.
,QUESTION
Which of the following privacy measures is designed to ensure that protected health
information (PHI) remains confidential and secure during electronic transmission?
A. Using data encryption software on office workstations
B. Shredding paper documents containing PHI
C. Locking filing cabinets containing PHI
D. Using password-protected screensavers
CORRECT ANS: A
Expert Rationale
Data encryption software is a critical security measure that converts electronic protected
health information (ePHI) into an unreadable format that can only be decoded with a
specific key. This ensures that even if data is intercepted during transmission, it cannot
be read by unauthorized third parties. This is a key requirement under HIPAA for
protecting ePHI. Options B, C, and D are also important privacy measures, but they
apply to physical documents or general security, not specifically to electronic
transmission.
QUESTION
Which of the following anatomical planes divides the body into left and right sections?
A. Sagittal plane
B. Coronal plane
C. Transverse plane
D. Frontal plane
CORRECT ANS: A
Expert Rationale
The sagittal plane is a vertical plane that runs from front to back, dividing the body into
right and left portions. A midsagittal plane divides the body into equal right and left
halves, while a parasagittal plane divides it into unequal right and left portions. Options
B and D are incorrect; the coronal (or frontal) plane divides the body into anterior (front)
and posterior (back) sections. Option C is incorrect; the transverse (or horizontal) plane
divides the body into superior (upper) and inferior (lower) sections.
, QUESTION
Which of the following provisions ensures that an insured individual's total benefits
from all insurance policies do not exceed 100% of the allowable medical expenses?
A. Coordination of benefits
B. Subrogation
C. Assignment of benefits
D. Reimbursement
CORRECT ANS: A
Expert Rationale
Coordination of Benefits (COB) is a provision in insurance contracts that prevents
duplicate payment and ensures that the total benefits paid by all insurance plans do not
exceed the total allowable medical expenses (100%). When a patient has multiple
insurance policies, the COB clause determines the order in which the plans pay (primary,
secondary, etc.) and ensures that the combined payment does not exceed the allowed
amount. Option B is incorrect; subrogation is the right of an insurer to recover payment
from a third party responsible for the loss. Option C is incorrect; assignment of benefits
is the transfer of the right to receive payment to the provider. Option D is incorrect;
reimbursement is the payment made to the provider.
QUESTION
When reviewing a delinquent claim, which of the following actions should be taken first?
A. Verify the age of the account.
B. Contact the insurance company.
C. Resubmit the claim.
D. Write off the balance.
CORRECT ANS: A
Expert Rationale
The first step in reviewing a delinquent claim is to verify the age of the account. This
involves checking the date of service and the date the claim was submitted to determine
how long the claim has been outstanding. This information is essential for prioritizing
NEWEST VERSION 2026 ACTUAL EXAM 103 + QUESTIONS AND
CORRECT DETAILED ANSWERS (VERIFIED ANSWERS)
|ALREADY GRADED A+.
QUESTION
In the context of insurance claims processing, which of the following terms refers to the
final determination made regarding the settlement of an insurance claim after it has
undergone a series of reviews and edits?
A. Adjudication
B. Reconciliation
C. Verification
D. Authorization
CORRECT ANS: A
Expert Rationale
Adjudication is the comprehensive process by which an insurance claim is reviewed,
evaluated, and a final determination is made regarding payment. This process involves a
series of automated and manual edits that check for errors, verify coverage, and apply
the patient's benefits. The outcome of adjudication is the determination of the amount
the insurance company will pay, the amount the patient owes, and any adjustments to
be made. Options B, C, and D are incorrect; reconciliation is the process of matching
payments to claims, verification is the process of confirming coverage, and authorization
is the process of obtaining approval for services.
QUESTION
A form that contains charges, dates of service (DOS), CPT codes, fees, and copayment
information is called which of the following?
A. Encounter form
B. Superbill
,C. Remittance advice
D. Explanation of benefits
CORRECT ANS: A
Expert Rationale
An encounter form (also known as a superbill) is a document used in a medical office to
record the services provided to a patient during a single visit. It typically includes the
date of service, the CPT and ICD codes for the services rendered, the fees charged, and
the patient's copayment information. This form serves as a source document for billing
and coding. Option B is a synonym for an encounter form, but A is the standard term.
Option C is incorrect; a remittance advice is a statement sent by the payer to the
provider. Option D is incorrect; an explanation of benefits is a statement sent to the
patient or provider explaining the payment decision.
QUESTION
A patient is admitted to the hospital for an inpatient procedure. Which of the following
hospital staff members is primarily responsible for the initial patient interview, obtaining
demographic and insurance information, and documenting the chief complaint?
A. Admitting clerk
B. Billing specialist
C. Registered nurse
D. Patient access representative
CORRECT ANS: A
Expert Rationale
The admitting clerk (or patient access representative) is responsible for the initial
registration of a patient upon admission to the hospital. This role involves conducting
the initial patient interview, collecting demographic and insurance information, verifying
eligibility, and documenting the reason for the visit (chief complaint) in the patient's
record. This process is crucial for ensuring accurate billing and reimbursement. Options
B, C, and D are incorrect; while they may have roles in patient care or billing, the
admitting clerk performs the specific duties described.
,QUESTION
Which of the following privacy measures is designed to ensure that protected health
information (PHI) remains confidential and secure during electronic transmission?
A. Using data encryption software on office workstations
B. Shredding paper documents containing PHI
C. Locking filing cabinets containing PHI
D. Using password-protected screensavers
CORRECT ANS: A
Expert Rationale
Data encryption software is a critical security measure that converts electronic protected
health information (ePHI) into an unreadable format that can only be decoded with a
specific key. This ensures that even if data is intercepted during transmission, it cannot
be read by unauthorized third parties. This is a key requirement under HIPAA for
protecting ePHI. Options B, C, and D are also important privacy measures, but they
apply to physical documents or general security, not specifically to electronic
transmission.
QUESTION
Which of the following anatomical planes divides the body into left and right sections?
A. Sagittal plane
B. Coronal plane
C. Transverse plane
D. Frontal plane
CORRECT ANS: A
Expert Rationale
The sagittal plane is a vertical plane that runs from front to back, dividing the body into
right and left portions. A midsagittal plane divides the body into equal right and left
halves, while a parasagittal plane divides it into unequal right and left portions. Options
B and D are incorrect; the coronal (or frontal) plane divides the body into anterior (front)
and posterior (back) sections. Option C is incorrect; the transverse (or horizontal) plane
divides the body into superior (upper) and inferior (lower) sections.
, QUESTION
Which of the following provisions ensures that an insured individual's total benefits
from all insurance policies do not exceed 100% of the allowable medical expenses?
A. Coordination of benefits
B. Subrogation
C. Assignment of benefits
D. Reimbursement
CORRECT ANS: A
Expert Rationale
Coordination of Benefits (COB) is a provision in insurance contracts that prevents
duplicate payment and ensures that the total benefits paid by all insurance plans do not
exceed the total allowable medical expenses (100%). When a patient has multiple
insurance policies, the COB clause determines the order in which the plans pay (primary,
secondary, etc.) and ensures that the combined payment does not exceed the allowed
amount. Option B is incorrect; subrogation is the right of an insurer to recover payment
from a third party responsible for the loss. Option C is incorrect; assignment of benefits
is the transfer of the right to receive payment to the provider. Option D is incorrect;
reimbursement is the payment made to the provider.
QUESTION
When reviewing a delinquent claim, which of the following actions should be taken first?
A. Verify the age of the account.
B. Contact the insurance company.
C. Resubmit the claim.
D. Write off the balance.
CORRECT ANS: A
Expert Rationale
The first step in reviewing a delinquent claim is to verify the age of the account. This
involves checking the date of service and the date the claim was submitted to determine
how long the claim has been outstanding. This information is essential for prioritizing
