NHA 2024-2025 CBCS Practice Questions (Set 2):
1. Which of the following is considered Protected Health Information (PHI)
under the Health Insurance Portability and Accountability Act (HIPPA)?: Patient's
email address
2. Emily, a 45-year old patient, has recently been diagnosed with a chronic
condition that requires ongoing treatment. Her primary insurance is through
her employer, but she also has a secondary insurance through her spouse's
employer. When submitting claims for Emily's treatment, what is the correct
order of billing to ensure proper coordination of benefits?: Submit the claim to the
primary insurance first, then the secondary insurance
3. Dr. Smith preformed a minor surgical procedure on John Doe at an out-
patient surgery center. Which place of service code should be used for this
procedure?: 24- procedures performed in an ambulatory surgery center ASC)
4. Sarah, a medical billing specialist, is reviewing the account of a patient
named John Doe. She notices that the insurance company has a lack of
pre-authorization for a specific procedure. What is the best course of action
for Sarah to take to resolve this issue?: Obtain the necessary pre-authorization and then resubmit
the claim
5. Dr. Smith is submitting a CMS-1500 claim form for patient named John Doe,
who received outpatient services covered by medicare. Which section of the
CMS-1500 form should Dr. Smith complete to indicate the type of insurance
plan covering John Doe?
- Box 1a- insured's ID Number
- Box 11- Insured Policy Group or FECA number
- Box 1- Insurance Type
- Box 24- Service Line Information: Box 1- Insurance Type
6. Which of the following is a primary purpose of internal audits in the context
of medical billing and coding?: To identify the correct coding errors before claim submissions
7. Dr. Smith's office received a request from John Does insurance company for
his medical records to process a claim. According to HIPPA regulations, what
is the most appropriate action for Dr. Smith's office to take?: Provide only the minimum
necessary information required to process the claim
, NHA 2024-2025 CBCS Practice Questions (Set 2):
8. When coding for Obstetrics, which of the following codes is used to indicate
a routine prenatal visit with no complications?
- Z34.00: Routine prenatal for normal first pregnancy no complications
- O09.89: Supervision of high risk pregnancy
- Z33.1: Encounter for pregnancy test
- O10.11: Pre-existing hypertension complicating pregnancy: Z34.00: Routine prenatal
for normal first pregnancy no complications
9. Sarah, a patient. has recently filled for bankruptcy. As a medical billing
specialist, what is the appropriate action to take regarding her outstanding
medical bills?: Cease all collection activities and notify the bankruptcy court
10. When coding for telemedicine services, which modifier should be append-
ed to indicate the service was provided via Telehealth?: Modifier 95
11. When a patient has multiple insurance plans, which insurance plan is typi-
cally considered the primary insurance?: The insurance plan provided by the patients employer
12. Sarah, a medical billing specialist, is verifying insurance eligibility for a
patient named John who has a commercial insurance plan. Which of the
following is a requirement she must fulfill to ensure that John's insurance
eligibility is verified correctly?: Confirm the patient's policy number and group number
13. Which of the following is the most crucial step in ensuring all applicable
charges are captured for optimal reimbursement?: Reviewing patient encounter forms and
progress notes
14. Sarah, a patient with a PPO insurance plan, needs to undergo a specialized
surgery. Her preferred surgeon is out-of-network. Which of the following
steps should Sarah take to understand her out-of-network coverage and po-
tential costs?: Contact her insurance company to verify out-of-network benefits and obtain pre-authorization
15. What is the first step in the insurance eligibility and benefits verification
process?: Verifying a patient's insurance coverage
16. Sarah visits her primary care physician for a routine check-up. Her insur-
ance plan has 20% coinsurance rate after meeting a $200 deductible. The total
bill for the visit is $500 , and Sarah has already met her deductible for the
year.How much is Sarah responsible for paying out-of-pocket for this visit?
- $100
, NHA 2024-2025 CBCS Practice Questions (Set 2):
- $200
- $300
- $400: $100
17. When coding for a total knee arthroplasty in an orthopedic speciality, which
of the following CPT codes is the most appropriate?: 27447
18. What is the primary purpose of a deductible in a health insurance policy?: To
ensure the patient shares in the cost of their healthcare services
19. Which of the following government insurance plans primarily covers indi-
viduals aged 65 and older, as well as certain individuals with disabilities?: -
Medicare
20. Mr. Johnson, a 68-year old patient, is enrolled in Medicare. He needs a com-
prehensive understanding of his coverage options. Which part of Medicare
will cover his inpatient hospital stay if he is admitted for a surgical procedure?-
: Medicare Part A
21. Dr. Smith performed a laparoscopic cholecystectomy on a 45-year old pa-
tient named John Doe. The procedure was uncomplicated, and the patient
was discharged the same day. Which CPT code should be used to accurately
represent the procedure?: 47562: Uncomplicated laparoscopic cholecystectomy
22. Sarah, a medical billing and coding specialist, is verifying insurance eligibil-
ity for a new patient, John Doe, who has recently switched to a new insurance
provider. What is the most crucial piece of documentation Sarah needs to
ensure John's insurance coverage is valid before proceeding with the billing
process?: A copy of John's new insurance card
23. Dr. Smith is submitting a CMS-1500 claim form for his patient John Doe, who
received outpatient services. Which field should Dr. Smith use to indicate the
diagnoses code for John Doe's condition?: Field 21
24. What is the primary purpose of verifying a patient's insurance eligibility
and benefits before rendering services?: To ensure the services will be covered by the patient's
insurance
25. Dr. Smith documents that his patient John Doe, has been diagnosed
with acute myocardial infarction (AMI) and has undergone a percutaneous
coronary intervention (PCI) with stent placement. Which of the following
1. Which of the following is considered Protected Health Information (PHI)
under the Health Insurance Portability and Accountability Act (HIPPA)?: Patient's
email address
2. Emily, a 45-year old patient, has recently been diagnosed with a chronic
condition that requires ongoing treatment. Her primary insurance is through
her employer, but she also has a secondary insurance through her spouse's
employer. When submitting claims for Emily's treatment, what is the correct
order of billing to ensure proper coordination of benefits?: Submit the claim to the
primary insurance first, then the secondary insurance
3. Dr. Smith preformed a minor surgical procedure on John Doe at an out-
patient surgery center. Which place of service code should be used for this
procedure?: 24- procedures performed in an ambulatory surgery center ASC)
4. Sarah, a medical billing specialist, is reviewing the account of a patient
named John Doe. She notices that the insurance company has a lack of
pre-authorization for a specific procedure. What is the best course of action
for Sarah to take to resolve this issue?: Obtain the necessary pre-authorization and then resubmit
the claim
5. Dr. Smith is submitting a CMS-1500 claim form for patient named John Doe,
who received outpatient services covered by medicare. Which section of the
CMS-1500 form should Dr. Smith complete to indicate the type of insurance
plan covering John Doe?
- Box 1a- insured's ID Number
- Box 11- Insured Policy Group or FECA number
- Box 1- Insurance Type
- Box 24- Service Line Information: Box 1- Insurance Type
6. Which of the following is a primary purpose of internal audits in the context
of medical billing and coding?: To identify the correct coding errors before claim submissions
7. Dr. Smith's office received a request from John Does insurance company for
his medical records to process a claim. According to HIPPA regulations, what
is the most appropriate action for Dr. Smith's office to take?: Provide only the minimum
necessary information required to process the claim
, NHA 2024-2025 CBCS Practice Questions (Set 2):
8. When coding for Obstetrics, which of the following codes is used to indicate
a routine prenatal visit with no complications?
- Z34.00: Routine prenatal for normal first pregnancy no complications
- O09.89: Supervision of high risk pregnancy
- Z33.1: Encounter for pregnancy test
- O10.11: Pre-existing hypertension complicating pregnancy: Z34.00: Routine prenatal
for normal first pregnancy no complications
9. Sarah, a patient. has recently filled for bankruptcy. As a medical billing
specialist, what is the appropriate action to take regarding her outstanding
medical bills?: Cease all collection activities and notify the bankruptcy court
10. When coding for telemedicine services, which modifier should be append-
ed to indicate the service was provided via Telehealth?: Modifier 95
11. When a patient has multiple insurance plans, which insurance plan is typi-
cally considered the primary insurance?: The insurance plan provided by the patients employer
12. Sarah, a medical billing specialist, is verifying insurance eligibility for a
patient named John who has a commercial insurance plan. Which of the
following is a requirement she must fulfill to ensure that John's insurance
eligibility is verified correctly?: Confirm the patient's policy number and group number
13. Which of the following is the most crucial step in ensuring all applicable
charges are captured for optimal reimbursement?: Reviewing patient encounter forms and
progress notes
14. Sarah, a patient with a PPO insurance plan, needs to undergo a specialized
surgery. Her preferred surgeon is out-of-network. Which of the following
steps should Sarah take to understand her out-of-network coverage and po-
tential costs?: Contact her insurance company to verify out-of-network benefits and obtain pre-authorization
15. What is the first step in the insurance eligibility and benefits verification
process?: Verifying a patient's insurance coverage
16. Sarah visits her primary care physician for a routine check-up. Her insur-
ance plan has 20% coinsurance rate after meeting a $200 deductible. The total
bill for the visit is $500 , and Sarah has already met her deductible for the
year.How much is Sarah responsible for paying out-of-pocket for this visit?
- $100
, NHA 2024-2025 CBCS Practice Questions (Set 2):
- $200
- $300
- $400: $100
17. When coding for a total knee arthroplasty in an orthopedic speciality, which
of the following CPT codes is the most appropriate?: 27447
18. What is the primary purpose of a deductible in a health insurance policy?: To
ensure the patient shares in the cost of their healthcare services
19. Which of the following government insurance plans primarily covers indi-
viduals aged 65 and older, as well as certain individuals with disabilities?: -
Medicare
20. Mr. Johnson, a 68-year old patient, is enrolled in Medicare. He needs a com-
prehensive understanding of his coverage options. Which part of Medicare
will cover his inpatient hospital stay if he is admitted for a surgical procedure?-
: Medicare Part A
21. Dr. Smith performed a laparoscopic cholecystectomy on a 45-year old pa-
tient named John Doe. The procedure was uncomplicated, and the patient
was discharged the same day. Which CPT code should be used to accurately
represent the procedure?: 47562: Uncomplicated laparoscopic cholecystectomy
22. Sarah, a medical billing and coding specialist, is verifying insurance eligibil-
ity for a new patient, John Doe, who has recently switched to a new insurance
provider. What is the most crucial piece of documentation Sarah needs to
ensure John's insurance coverage is valid before proceeding with the billing
process?: A copy of John's new insurance card
23. Dr. Smith is submitting a CMS-1500 claim form for his patient John Doe, who
received outpatient services. Which field should Dr. Smith use to indicate the
diagnoses code for John Doe's condition?: Field 21
24. What is the primary purpose of verifying a patient's insurance eligibility
and benefits before rendering services?: To ensure the services will be covered by the patient's
insurance
25. Dr. Smith documents that his patient John Doe, has been diagnosed
with acute myocardial infarction (AMI) and has undergone a percutaneous
coronary intervention (PCI) with stent placement. Which of the following
