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ick J. Hurley All 14 chapters covered
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NHA CBCS Exam () Actual Questions and Verified Answ
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ers & Rationales / A+ Grade 100% Guarantee
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Which nofnthenfollowingnactionsnshouldnthenCBCSntakentonpreventnfraudnandnabuseninnthenme
dical noffice?
-Servicednprocedurenpreauthorization
-Internal nmonitoringnandnauditing
-Utilization nreview
-Correctncodingninitiativen-nInternal nmonitoringnandnauditing
In nan noutpatientnsetting,nwhichnof nthenfollowingnformsnisnusednasnanfinancial nreportnof nallnser
vicesnprovidedntonpatients?
-Encounternform
-Patientnaccountnrecord
-CMS-1500nclaimnform
-Accountsnreceivablenjournal n-
nPatientnaccountnrecordn(patientnledger,nallntransactionsnbetween npatientnandnthenpractice)
-
Accountsnreceivablenjournal n(Daynsheetn=nchronologicalnsummarynofnall ntransaction non nans
pecificnday)
Patientnchargesnthatnhavennotnbeen npaidnwill nappearnin nwhich nof nthenfollowing?
-Accountsnreceivable
-Accountsnpayable
-Tracer
-Rejectednclaimn-nAccountsnreceivable
Which nofnthenfollowingnisnconsiderednthenfinal ndeterminationnof nthenissuesninvolvingnsettlem
entnof nan ninsurancenclaim?
-Processing
-Translation
-Adjudication
-Transmission n-
nAdjudication n(processnofnputting nanclaimnthrough nanseriesnofneditsnfornfinal ndetermination)
-Processingn(nhandlingnanclaimnfromnthenfirstnencounterntonclaimnsubmission)
-Translation n(claimnisnsendnfromnthenhostnsystemntonthenclearingnhouse)
-Transmission n(how nthenclaimnwasnsent)
Which nof nthenfollowingninformation nshouldnthenCBCSninputnintonblockn33anon nthenCMS-
n1500nclaimnform
-Providernsocial nsecuritynnumbern(nonSocial nsecuritynnumbernon nCMS1500)
-Federal ntaxnidnnumbern(enterednin nblockn25)
-Patientnidnnumbern(on nblockn1a)
-National nprovidernidentification nnumbern-nNational nprovidernidentification nnumber
,Anprospectivenbillingnaccountnauditnpreventsnfraudnbynreviewingnandncomparingnancomplete
dnclaimnformnwith nwhich nof nthenfollowingndocuments?
-Anbillingnworksheetnfromnthenpatientnaccount
-Ansuperbill
-Andaynsheet
-Amnaccountsnreceivablenreportnof nthenpatientnaccountn-
nA nbilling nworksheetnfromnthenpatientnaccount
When nanpatientnhasnanconditionnthatnisnbothnacutenandnchronic,nhownshouldnitnbenreported?
-Codenonlynthenacutencode
-Codenboth nacutenandnchronic,nsequencingnthenacutenfirst
-Codenonlynthenchronicncode
-Codenboth nacutenandnchronic,nsequencingnthenchronicnfirstn-
nCodenboth nacutenandnchronic,nsequencing nthenacutenfirst
Which nofnthenfollowingntypesnofnhealthninsurancenplannbestndescribesnangovernmentnspons
orednbenefitnprogram?
-Unemploymentncompensation ndisability
-TRICAREnprime
-Foundation nfornMedicare
-Worker'sncompensation n-nTRICARE nprime
-
Unemploymentncompensationndisabilityn(stateninsurancencoveringnnonnworknrelatednillness
nandninjury)
Acceptingnassignmentnon nthenCMS-1500nclaimnformnindicatesnwhich nof nthenfollowing?
-Thenpatientnagreesntonacceptnpaymentnandnforwardnthenpaymentntonthenphysician
-Thenphysician nagreesntonacceptnpaymentnundernthentermsnof nthenpayer'snprogram.
-Thenphysician nagreesntonbill naccordingnthenthirdnpayer'snfeenschedule
-
Thenpatientnagreesntonpaynthendifferencenbetweennthenbillednamountnandnthenallowednamou
ntn-nThenphysician nagreesntonacceptnpaymentnundernthentermsnof nthenpayer'snprogram.
Which nof nthenfollowingnpartsnof nthenbodynsystemnregulatesnimmunity?
-Endocrinensystemn(regulatesngrowth,nmetabolic)
-Respiratorynsystemn(removesncarbon ndioxide)
-Urinarynsystemn(filtersnbloodntonremovenwastenof ncellularnmetabolism)
-Lymphaticnsystemn-nLymphaticnsystem
-Endocrinensystemn(regulatesngrowth,nmetabolic)
-Respiratorynsystemn(removesncarbon ndioxide)
-Urinarynsystemn(filtersnbloodntonremovenwastenof ncellularnmetabolism)
Which nofnthenfollowingnsectionsnof nthenmedicalnrecordnisnusedntondeterminenthencorrectneval
uation nandnmanagementncodentonusenfornbillingnandncoding?
-Codesnusednduringnpriornpatientnvisits
,-Patient'sninsurancenplan
-Plan nof ncare
-Historynandnphysical n-nHistorynandnphysical
Anpatient'snhealthnplannisnreferredntonasnthenpayernofnlastnresort.nThenpatientnisncoverednbynw
hich nof nthenfollowingnhealth nplans?
Medicaidn
CHAMPA
Medicare
TRICAREn-nMedicaid
Anprovidernchargedn$500ntonanclaimnthatnhadnannallowablenamountnof n$400.nInnwhich nof nth
enfollowingncolumnsnshouldnthenCBCSnapplynthennon nallowedncharge?
-Referencencolumn n(Fornnotations)
-Description ncolumn
-Paymentncolumn
-Adjustmentncolumn nof nthencreditsn-nAdjustmentncolumn nof nthencredits
Which nof nthenfollowingnstatementsnisncorrectnregardingnandeductible?
-Coinsurancenisnantypenof ndeductible
-Thenphysician nshouldnwritenoff nthendeductible
-Theninsurancencompanynpaysnfornthendeductible
-Thendeductiblenisnthenpatient'snresponsibilityn-nThendeductiblenisnthenpatient'snresponsibility
Which nof nthenfollowingncolornformatsnallowsnoptical nscanningnof nthenCMS-
1500nclaimnform?
-Red
-Blue
-Green
-blackn-nred
Ambulatorynsurgeryncenters,nhomenhealth nandnhospicenorganizationsnusenthe .
-CMS-1500nclaimnform
-UB-04nclaimnform
-AdvancenBeneficiarynnotice
-Firstnreportnof ninjurynformn-nUB-04
ClaimsnthatnarensubmittednwithoutnannNPInnumbernwill ndelaynpaymentntonthenprovidernb
ecause .
-Thennumbernisnthenpatient'nidnnumber
-Thennumbernisnneededntonidentifynthenprovider
-Isnisnusednasnanclaimnnumber
-Itnisnusednasnanprenauthorizationnnumbern-nThennumbernisnneededntonidentifynthenprovider
, Which nofnthenfollowingntermsndescribesnwhennanplannpaysn70%nof nthenallowednamountnand
nthenpatientnpaysn30%?
-Coinsurance
-Deductible
-Premium
-copaymentn-ncoinsurance
Which nofnthenfollowingnindicatesnanclaimnshouldnbensubmittednonnpaperninsteadnofnelectroni
cally?
-Thensoftwarenclaimsnreview nprocessnindicatesnthenclaimnisnnotncomplete
-Thenclaimnneedsnauthorization
-Thenclaimnrequiresnan nattachment
-Thenpracticenmanagementnsoftwarenisnnonnfunctional.n-nthenclaimnrequiresnannattachment
On nanremittancenadvicenform,nwhichnofnthenfollowingnisnresponsiblenfornwritingnoff nthendiffere
ncenbetween nthenamountnbillednandnthenamountnallowednbynthenagreement?
-Provider
-Insurancencompany
-Patient
-Thirdnpartynpayern-nprovider
Anphysiciannisncontractednwithnanninsurancencompanyntonacceptnthenamount.nTheninsuranc
encompanynallowsn$80nofnan$120nbillednamount,nandn$50nof nthendeductiblenhasnnotnbeen nm
et.nHow nmuch nshouldnthenphysician nwritenoff nthenpatient'snaccount?
-$40
-$15
-$0
-$50n-n$40
Thenunlistedncodesncannbenfoundninnwhich nof nthenfollowingnlocationsnin nthenCPTnmanual?
-AppendixnL
-Guidelinesnpriorntoneach nsection
-Endnof neach nbodynsystem
-Tablenof ncontentsn-nGuidelinesnpriorntoneach nsection
Which nofnthenfollowingnblocksnshouldnthenbillingnandncodingnspecialistncompletenthenCMSn1
500nclaimsnformnfornprocedure,nservicesnornsupplies?
-Blockn12
-Blockn2
-Blockn24D
-Blockn24Jn-nBlockn24D
-Blockn12n(patient'snauthorization nblock
-Blockn2n(npatient'snname)
-Blockn24Jn(nfornthenrenderingnprovider)