NHA CBCS 3.0 PRACTICE TEST
1. A child is brought into a facility by their mother. The child is covered
under both parents' insurance policies. The child's father was born on
10/1/1980 and their mother was born on 10/2/1981. Which of the following
statements is true regarding the primary policy holder for the child?: The
father is the primary policy holder because his birthday falls first in the calendar
year.
2. A billing and coding specialist is submitting a claim for a school-age
child who was brought to the clinic by their maternal grandmother. The child's
parents are divorced and remarried, and the child's mother has legal custody
of the child. The specialist should recognize that the child's primary
insurance coverage is provided through which of the following insured
individuals?: Biologic mother
3. Which of the following is the purpose of running an insurance aging
report each month?: To determine which claims are outstanding from third-party
payers 4. A billing and coding specialist observes a colleague perform an
unethical act. Which of the following actions should the specialist take?:
Report the incident to a supervisor
5. Which of the following statements is true regarding the release of
patients records?: Patient access to psychotherapy notes is restricted
6. A billing and coding specialist is preparing a claim for a patient who had
a procedure performed on their left index finger. Which of the following
modifiers indicates the correct digit?: -F1
-FA: used for left thumb
-F6: used for right index finger -F4:
used for the left pinky
7. A billing and coding specialist is processing a claim for a patient who
broke their arm while repairing cars at their workplace. There is no nerve
damage, the arm is placed in a cast for 6 weeks, and the patient is
cleared to return to work in 6 weeks. Which of the following types of
workers' compensation applies to this patient?: Temporary disability
8. Based on the CPT integumentary coding guidelines, Mohs micrographic
surgery involves the provider filling which of the following roles?: Both
the surgeon and pathologist
9. A billing and coding specialist is preparing a claim for a provider. The
operative note indicates the surgeon performed a CABG. The specialist
, NHA CBCS 3.0 PRACTICE TEST
should identify that CABG stands for which of the following?: Coronary
Artery Bypass Graft
10. A billing and coding specialist is arranging a payment plan with a patient
who wants to leave postdated checks with the office. The patient
proposes leaving one check postdated for 3 months, one for 4 months,
and another one for 5 months in the future. According to federal
collection law, which of the following actions should the specialist take?:
Notify the patient between 3 and 10 days prior to depositing each check on the
indicated date.
11. Which of the following qualifies a patient for eligibility under Medicare as
the primary third-party payer?: Individuals who are under age 65 and have
a disability
12. Which of the following is an example of a diagnostic category code?: I10
(Diagnostic category codes contains three characters)
13. A billing and coding specialist is determining third-party payer
responsibilities for a 70-year-old patient who has Medicare coverage.
The patient's spouse has insurance with Blue Cross Blue Shield through
their employer. Which of the following actions should the specialist
take?: Establish coordination of benefits
14. When a patient has a condition that is both acute and chronic, how
should it be coded?: Code both the acute and chronic conditions,
sequencing the acute condition first.
15. When reviewing an established patient's insurance card, a billing and
coding specialist notices a minor change from the existing card on file.
Which of the following actions should the specialist take?: Photocopy
both sides of the new card
16. On a remittance advice form, which of the following is responsible for
writing off the difference between the amount billed and the amount
allowed by the agreement?: Provider
17. A provider's office receives a subpoena requesting medical
documentation from a patient's medical record. After confirming the
correct authorization, which of the following actions should a billing and
coding specialist take?: Send the medical information pertaining to the dates
of service requested.
18. A billing and coding specialist is working on a claim in which
reimbursement was reduced due to services being bundled. Which of the
, NHA CBCS 3.0 PRACTICE TEST
following types of modifiers should be assigned to indicate multiple
procedures were performed to prevent bundling?: Category I modifier
(category I modifier provides the means to report or indicate that a service or
procedure that has been performed has been altered by some specific circumstance
but not changed in its definition or code).
19. A billing and coding specialist is reviewing an encounter note that
indicates a biopsy was performed. The specialist requires which of the
following additional details to fully code this procedure?: Benign vs.
malignant status
20. A billing and coding specialist is determining the level of service for an
office visit for a new patient. Which of the following codes represents a
detailed history and detailed exam with moderate medical decision-
making?: 99204 21. Which of the following is true regarding Medicaid
eligibility?: Patient eligibility is determined at each visit.
22. Which of the following pieces of guarantor information is required when
establishing a patient's financial record?: Phone number
23. A billing and coding specialist is reviewing a delinquent claim. Which of
the following actions should the specialist take first?: Verify the age of the
account. 24. When a patient signs an Acknowledgement of Notice of Privacy
Practice, it indicates which of the following?: The patient accepts the policies
and procedures regarding how protected health information (PHI) is handled.
25. Which of the following should a billing and coding specialist complete to
be reimbursed for a provider's outpatient services?: CMS-1500 claim form 26.
A billing and coding specialist is preparing a claim for an appendectomy
and reports it with two units. The claim is then denied. Which of the
following coding edits should the specialist have reviewed prior to
submitting the claim?: Medically unlikely edits (MUEs)
27. A billing and coding specialist identifies a CPT code that is routinely
being denied by a third-party payer. Which of the following types of review
should the specialist perform?: Retrospective review
28. In which of the following sections of the SOAP note does a provider
indicate a patient's reported level of pain?: Subjective
(where the patient describes the chief of complaint; including the patient's reported
level of pain)
1. A child is brought into a facility by their mother. The child is covered
under both parents' insurance policies. The child's father was born on
10/1/1980 and their mother was born on 10/2/1981. Which of the following
statements is true regarding the primary policy holder for the child?: The
father is the primary policy holder because his birthday falls first in the calendar
year.
2. A billing and coding specialist is submitting a claim for a school-age
child who was brought to the clinic by their maternal grandmother. The child's
parents are divorced and remarried, and the child's mother has legal custody
of the child. The specialist should recognize that the child's primary
insurance coverage is provided through which of the following insured
individuals?: Biologic mother
3. Which of the following is the purpose of running an insurance aging
report each month?: To determine which claims are outstanding from third-party
payers 4. A billing and coding specialist observes a colleague perform an
unethical act. Which of the following actions should the specialist take?:
Report the incident to a supervisor
5. Which of the following statements is true regarding the release of
patients records?: Patient access to psychotherapy notes is restricted
6. A billing and coding specialist is preparing a claim for a patient who had
a procedure performed on their left index finger. Which of the following
modifiers indicates the correct digit?: -F1
-FA: used for left thumb
-F6: used for right index finger -F4:
used for the left pinky
7. A billing and coding specialist is processing a claim for a patient who
broke their arm while repairing cars at their workplace. There is no nerve
damage, the arm is placed in a cast for 6 weeks, and the patient is
cleared to return to work in 6 weeks. Which of the following types of
workers' compensation applies to this patient?: Temporary disability
8. Based on the CPT integumentary coding guidelines, Mohs micrographic
surgery involves the provider filling which of the following roles?: Both
the surgeon and pathologist
9. A billing and coding specialist is preparing a claim for a provider. The
operative note indicates the surgeon performed a CABG. The specialist
, NHA CBCS 3.0 PRACTICE TEST
should identify that CABG stands for which of the following?: Coronary
Artery Bypass Graft
10. A billing and coding specialist is arranging a payment plan with a patient
who wants to leave postdated checks with the office. The patient
proposes leaving one check postdated for 3 months, one for 4 months,
and another one for 5 months in the future. According to federal
collection law, which of the following actions should the specialist take?:
Notify the patient between 3 and 10 days prior to depositing each check on the
indicated date.
11. Which of the following qualifies a patient for eligibility under Medicare as
the primary third-party payer?: Individuals who are under age 65 and have
a disability
12. Which of the following is an example of a diagnostic category code?: I10
(Diagnostic category codes contains three characters)
13. A billing and coding specialist is determining third-party payer
responsibilities for a 70-year-old patient who has Medicare coverage.
The patient's spouse has insurance with Blue Cross Blue Shield through
their employer. Which of the following actions should the specialist
take?: Establish coordination of benefits
14. When a patient has a condition that is both acute and chronic, how
should it be coded?: Code both the acute and chronic conditions,
sequencing the acute condition first.
15. When reviewing an established patient's insurance card, a billing and
coding specialist notices a minor change from the existing card on file.
Which of the following actions should the specialist take?: Photocopy
both sides of the new card
16. On a remittance advice form, which of the following is responsible for
writing off the difference between the amount billed and the amount
allowed by the agreement?: Provider
17. A provider's office receives a subpoena requesting medical
documentation from a patient's medical record. After confirming the
correct authorization, which of the following actions should a billing and
coding specialist take?: Send the medical information pertaining to the dates
of service requested.
18. A billing and coding specialist is working on a claim in which
reimbursement was reduced due to services being bundled. Which of the
, NHA CBCS 3.0 PRACTICE TEST
following types of modifiers should be assigned to indicate multiple
procedures were performed to prevent bundling?: Category I modifier
(category I modifier provides the means to report or indicate that a service or
procedure that has been performed has been altered by some specific circumstance
but not changed in its definition or code).
19. A billing and coding specialist is reviewing an encounter note that
indicates a biopsy was performed. The specialist requires which of the
following additional details to fully code this procedure?: Benign vs.
malignant status
20. A billing and coding specialist is determining the level of service for an
office visit for a new patient. Which of the following codes represents a
detailed history and detailed exam with moderate medical decision-
making?: 99204 21. Which of the following is true regarding Medicaid
eligibility?: Patient eligibility is determined at each visit.
22. Which of the following pieces of guarantor information is required when
establishing a patient's financial record?: Phone number
23. A billing and coding specialist is reviewing a delinquent claim. Which of
the following actions should the specialist take first?: Verify the age of the
account. 24. When a patient signs an Acknowledgement of Notice of Privacy
Practice, it indicates which of the following?: The patient accepts the policies
and procedures regarding how protected health information (PHI) is handled.
25. Which of the following should a billing and coding specialist complete to
be reimbursed for a provider's outpatient services?: CMS-1500 claim form 26.
A billing and coding specialist is preparing a claim for an appendectomy
and reports it with two units. The claim is then denied. Which of the
following coding edits should the specialist have reviewed prior to
submitting the claim?: Medically unlikely edits (MUEs)
27. A billing and coding specialist identifies a CPT code that is routinely
being denied by a third-party payer. Which of the following types of review
should the specialist perform?: Retrospective review
28. In which of the following sections of the SOAP note does a provider
indicate a patient's reported level of pain?: Subjective
(where the patient describes the chief of complaint; including the patient's reported
level of pain)
