NHA CBCS CERTIFICATION EXAM AND
PRACTICE EXAM
When does communication with the
patient begin?
A. Patient check-in
B. Registration and scheduling
C. Health care encounter
D. Patient Check Out - ANSWER B. Registration and scheduling.
Explanation: Communication starts at the
point of service, during registration and
scheduling, where the information is gathered
from the patient to create an account
What is a third-party payer? - ANSWER Healthcare insurance company
that reimburses services
provided by providers and/
or health care organizations.
Terminology - ANSWER As health care changes, so do the terms
we use. It is important to know and use
current health care terminology. For
example, the CMS-1500 (paper) form was
previously called the HCFA-1500 form.
What is a provider? - ANSWER A provider is a licensed professional
who can submit claims to a third-
party payer. This individual can be a
physician, nurse practitioner, physical or
occupational therapist, hospital, or any
qualified professional who is licensed
to provide health care services
What are the Office of Inspector General responsible for? - ANSWER The OIG is a
division of the Department of Health and Human Services (HHS) and is responsible
for investigating insurance fraud and abuse related to Medicare, Medicaid, and other
federally funded programs.
What is the intent of the Office of the
Inspector General? - ANSWER Identify and eliminate fraud, abuse, and waste
, Covered entity. - ANSWER Entity that transmits health information in electronic form
(e.g., providers, health plans, clearinghouses)
Electronic Data Interchange. - ANSWER Computer technology that contains the
exchange of data between the health care provider and payer
Fraud - ANSWER Intentionally billing for services not performed, reporting fraudulent
diagnosis, or medical coding errors.
Abuse - ANSWER Billing patterns and practices that are excessive or unnecessary
but not fraudulent.
HIPAA - ANSWER HIPAA not only protects protected health
information (PHI) in electronic or paper
records, but PHI is also protected in the
verbal form. A conversation with another staff
member can violate PHI depending on where
and how the conversation takes place.
Clinical Use - ANSWER Information about type and quality of care
Transmission - ANSWER Patient eligibility
Storage - ANSWER Backup
Administrative Use - ANSWER Quality improvement
How can a compliance program help an
organization? - ANSWER By providing the guidance and structure needed to meet
the goals of compliance
What is the purpose of Self-Disclosure
Protocol? - ANSWER Self-disclosure allows for a provider or organization to
voluntarily report any evidence of potential fraud. The voluntary disclosure allows the
provider or organization to work with the OIG to resolve the issues identified in a fair
manner.
Accounts Receivable - ANSWER The amount owed to a provider for health care
services rendered.
TAKE NOTE - ANSWER When patient data is entered
incorrectly, there will be a delay
at the point of claim processing.
The insurance plan cannot process
a claim for reimbursement if the
patient's date of birth cannot be
identified with the policy number.
Delayed claims prevent payment to
the provider, which can then affect
accounts payable.
PRACTICE EXAM
When does communication with the
patient begin?
A. Patient check-in
B. Registration and scheduling
C. Health care encounter
D. Patient Check Out - ANSWER B. Registration and scheduling.
Explanation: Communication starts at the
point of service, during registration and
scheduling, where the information is gathered
from the patient to create an account
What is a third-party payer? - ANSWER Healthcare insurance company
that reimburses services
provided by providers and/
or health care organizations.
Terminology - ANSWER As health care changes, so do the terms
we use. It is important to know and use
current health care terminology. For
example, the CMS-1500 (paper) form was
previously called the HCFA-1500 form.
What is a provider? - ANSWER A provider is a licensed professional
who can submit claims to a third-
party payer. This individual can be a
physician, nurse practitioner, physical or
occupational therapist, hospital, or any
qualified professional who is licensed
to provide health care services
What are the Office of Inspector General responsible for? - ANSWER The OIG is a
division of the Department of Health and Human Services (HHS) and is responsible
for investigating insurance fraud and abuse related to Medicare, Medicaid, and other
federally funded programs.
What is the intent of the Office of the
Inspector General? - ANSWER Identify and eliminate fraud, abuse, and waste
, Covered entity. - ANSWER Entity that transmits health information in electronic form
(e.g., providers, health plans, clearinghouses)
Electronic Data Interchange. - ANSWER Computer technology that contains the
exchange of data between the health care provider and payer
Fraud - ANSWER Intentionally billing for services not performed, reporting fraudulent
diagnosis, or medical coding errors.
Abuse - ANSWER Billing patterns and practices that are excessive or unnecessary
but not fraudulent.
HIPAA - ANSWER HIPAA not only protects protected health
information (PHI) in electronic or paper
records, but PHI is also protected in the
verbal form. A conversation with another staff
member can violate PHI depending on where
and how the conversation takes place.
Clinical Use - ANSWER Information about type and quality of care
Transmission - ANSWER Patient eligibility
Storage - ANSWER Backup
Administrative Use - ANSWER Quality improvement
How can a compliance program help an
organization? - ANSWER By providing the guidance and structure needed to meet
the goals of compliance
What is the purpose of Self-Disclosure
Protocol? - ANSWER Self-disclosure allows for a provider or organization to
voluntarily report any evidence of potential fraud. The voluntary disclosure allows the
provider or organization to work with the OIG to resolve the issues identified in a fair
manner.
Accounts Receivable - ANSWER The amount owed to a provider for health care
services rendered.
TAKE NOTE - ANSWER When patient data is entered
incorrectly, there will be a delay
at the point of claim processing.
The insurance plan cannot process
a claim for reimbursement if the
patient's date of birth cannot be
identified with the policy number.
Delayed claims prevent payment to
the provider, which can then affect
accounts payable.
