NHA CBCS Practice Questions Set 1 2024–2025 | Certified Billing & Coding Specialist Exam Review

NHA./2024-2025./CBCS./Practice./Questions./(Set./1):

1. What./is./the./first./step./in./verifying./a./patient's./insurance./information?:./Review./the./
patient's./insurnace./card./for./policy./number./and./group./number
2. What. / is. / the. / most. / crucial. / step. / in. / verifying. / a. / patient's. / insurance. / informatio
n. / before./providing./medical./services?:./Verifying./a./patients./eligibility./and./benefits./directly./with./t
he./insurance./company
3. Which. / of. / the. / following. / is. / a. / primary. / characteristic. / of. / workers'. / compensation
. / plans?:./They./cover./medical./expenses./and./lost./wages./due./to./work./related./injuries


4. What. / is. / the. / primary. / step. / a. / medical. / billing. / and. / coding. / specialist. / should. / ta
ke./when./a./claim./is./denied./by./a./third./party./payer?:./Review./the./Explanation./of./benefits./(EOB)./t
o./determine./the./reason./for./denial
5. When. / filling. / a. / claim. / with. / multiple. / insurance. / carriers,. / which. / insurance. / should
./be./billed./first?:./The./primary./insurance./of./the./patient


6. When./coding./from./an./operative./report,./which./section./typically./contains./the./
most./detailed./description./of./surgical./procedure./performed?:./Operative./note
7. What. / is. / the. / primary. / purpose. / of. / the. / explanation. / of. / benefits. / (EOB). / docume
nt./in./the./revenue./cycle./management./process?:./To./outline./the./patient's./payment./responsibiliti
es./and./the./payer's./payment./decisions
8. Dr../Smith's./clinic./has./recently./implemented./a./compliance./plan./to./ensure./ad
herence./regulatory./standards../During./an./internal./audit,./it./was./discovered./that
./an./overpayment./was./received ./from./Medicare./for./services./rendered ./to./a./pati


ent./named./John./Doe.
According. / to. / the. / Provider. / Self-
Disclosure. / Protocol. / (SDP),. / what. / is. / the. / appropri-
ate./action./Dr../Smith's./clinic./should./take?:./Report./the./overpayment./to./Medicare./within./60./days
9. Sarah. / a. / medical. / billing. / and. / coding. / specialist. / is. / reviewing. / a. / claim. / that. / wa
s./denied. / by. / a. / third-party. / payer. / due-
to. / "lack. / of. / medical. / necessity.". / Which. / of. / the./following./actions./should./Sarah./take./
to./address./this./denial?:./Appeal./the./denial./with./supporting./documentation./from./the./patient's./medi
cal./record
10. 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./Pref

, NHA./2024-2025./CBCS./Practice./Questions./(Set./1):

erred./Provider./Organization./(PPO)./while./another./is./a./Health./Maintenance./Org
anization./(HMO)../John./values./having./the./flexibility./to./see

, NHA./2024-2025./CBCS./Practice./Questions./(Set./1):

specialists. / without. / needing. / a. / referral.. / Which. / plan. / should. / choose. / to. / best. / me
et./his./needs?:./Preferred./Provider./Organization./(PPO)
11. During. / the. / pre-
authorization. / process. / for. / a. / complex. / surgical. / procedure,./the. / insurance. / co
mpany. / request. / additional. / documentation. / or. / verify. / medical./necessity.. / As. / t
he. / medical. / billing. / specialists,. / how. / should. / you. / clearly. / and. / ac-
curately. / communicate. / this. / requirement. / to. / Dr.. / Smith,. / the. / surgeon,. / to. / ensure
. / timely./compliance?:./Schedule./a./meeting./with./Dr../Smith./to./discuss./the./specific./documents./required./an


d./their./importance.
12. Doctor. / Smith. / submitted. / a. / claim. / for. / a. / patient. / named. / John. / Doe,. / who. / und
er./went. / a. / minor. / surgical. / procedure.. / The. / claim. / was. / denied. / due. / to. / a. / code. / e
dit./indicating. / a. / bundling. / issue.. / What. / should. / the. / medical. / biller. / do. / first. / to. / res
olve. / this./issue?:./Review./the./National./Correct./Coding./Initiative./(NCCI)./Edits
13. John./a./patient./is./undergoing./treatment./for./a./chronic./condition../During./the./vi
sit,./the./healthcare./provider./discusses./the./importance./of./accurately./docu-
menting./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. / accur
ate./communication./with./stakeholders./throughout./the./revenue./cycle?:./Verifying./that./
all./treatment./codes./are./entered./correctly./into./the./Electronic./Health./Record./(EHR).
14. What. / is. / the. / purpose. / of. / Local. / Coverage. / Determination. / (LCD). / in. / the. / conte
xt./of./medical./billing./and./reimbursement?:. / To./define./specific./coverage./criteria./for./services./at./the./l
ocal./level
15. When./is./it./important./to./issue./an./Advanced./Beneficiary./Notice./(ABN)./to./a./Medi
care./patient?:./When./the./provider./believes./Medicare./will./likely./deny./payment./for./a./service
16. What./is./the./primary./limitation./of./Medicare./Part./B./coverage./for./out./patient./service
s?:. / It./requires./beneficiaries./to./pay./an./annual./deductible./and./20%./coinsurance./for./most./services
17. Doctor./Smith./administered./general./anesthesia./to./a./45./year./old./patient,./John. /
Doe,. / for. / a. / complex. / abdominal. / surgery. / that. / lasted. / 3. / hours.. / Which. / CPT. / cod
e./should. / be. / used. / to. / accurately. / report. / the. / anesthesia. / services. / provided?:. / 00
860
18. Sarah./a./medical./billing./specialists,./is./reviewing./a./a./patient's./insurance./claim./for