NHA CBCS EXAM REVIEW FINAL PAPER 2026
EXAM PREP QUESTIONS AND SOLUTIONS
◉ A patient's employer has not submitted a premium payment.
Which of the following claim statuses should the provider receive
from the third-party payer? Answer: Denied
◉ A billing and coding specialist should routinely analyze which of
the following to determine the number of outstanding claims?
Answer: Aging report
◉ Which of the following should a billing and coding specialist use
to submit a claim with supporting documents? Answer: Claims
attachment
◉ Which of the following terms is used to communicate why a claim
line item was denied or paid differently than it was billing? Answer:
Claim adjustment codes
◉ On a CMS-1500 claim form, which of the following information
should the billing and coding specialist enter into Block 32? Answer:
Service facility location information
,◉ 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 the
billing and coding specialist take? Answer: Send the medical
information pertaining to the dates of service requested
◉ Which of the following is the deadline for Medicare claim
submission? Answer: 12 months from the date of service
◉ Which of the following forms does a third-party payer require for
physician services? Answer: CMS-1500
◉ A patient who is an active member of the military recently
returned from overseas and is in need of specialty care. The patient
does not have anyone designed with power of attorney. Which of the
following is considered a HIPAA violation? Answer: The billing and
coding specialist sends the patient's records to the patient's partner.
◉ Which of the following terms refers to the difference between the
billing and allowed amounts? Answer: Adjustment
◉ Which of the following HMO managed care services requires a
referral? Answer: Durable medical equipment
,◉ Which of the following explains why Medicare will deny a
particular service or procedure? Answer: Advance Beneficiary
Notice (ABN)
◉ Which of the following types of claims is 120 days old? Answer:
Delinquent
◉ When reviewing an established patient's insurance card, the
billing and coding specialist notices a minor change from the
existing card on file. Which of the following actions should the
billing and coding specialist take? Answer: Photocopy both sides of
the new card
◉ A husband and wife each have group insurance through their
employers. The wife has an appointment with her provider. Which
insurance should be used as primary for the appointment? Answer:
The wife's insurance
◉ Which of the following would most likely result in a denial on a
Medicare claim? Answer: An experimental chemotherapy
medication for a patient who has stage III renal cancer
◉ Which of the following pieces of guarantor information is
required when establishing a patient's financial record? Answer:
Phone number
, ◉ A provider surgically punctures through the space between the
patient's ribs using an aspirating needle to withdraw fluid from the
chest cavity. Which of the following is the name of this procedure?
Answer: Pleurocentesis
◉ A patient has AARP as secondary insurance. In which of the
following blocks on the CMS-1500 claim form should the
information be entered? Answer: Block 9
◉ A Medicare non-participating (non-PAR) provider's approved
payment amount is $200 for a lobectomy and the deductible has
been met. Which of the following amounts is the limiting charge for
this procedure? Answer: $230
**A non-PAR who does not accept assignment, can collect a
maximum of 15% (the limiting charge) over the non-PAR Medicare
fee schedule amount.
◉ In the anesthesia section of the CPT manual, which of the
following are considered qualifying circumstances? Answer: Add-on
codes
◉ Threading a catheter with a balloon into a coronary artery and
expanding it to repair arteries describes which of the following
procedures? Answer: Angioplasty
EXAM PREP QUESTIONS AND SOLUTIONS
◉ A patient's employer has not submitted a premium payment.
Which of the following claim statuses should the provider receive
from the third-party payer? Answer: Denied
◉ A billing and coding specialist should routinely analyze which of
the following to determine the number of outstanding claims?
Answer: Aging report
◉ Which of the following should a billing and coding specialist use
to submit a claim with supporting documents? Answer: Claims
attachment
◉ Which of the following terms is used to communicate why a claim
line item was denied or paid differently than it was billing? Answer:
Claim adjustment codes
◉ On a CMS-1500 claim form, which of the following information
should the billing and coding specialist enter into Block 32? Answer:
Service facility location information
,◉ 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 the
billing and coding specialist take? Answer: Send the medical
information pertaining to the dates of service requested
◉ Which of the following is the deadline for Medicare claim
submission? Answer: 12 months from the date of service
◉ Which of the following forms does a third-party payer require for
physician services? Answer: CMS-1500
◉ A patient who is an active member of the military recently
returned from overseas and is in need of specialty care. The patient
does not have anyone designed with power of attorney. Which of the
following is considered a HIPAA violation? Answer: The billing and
coding specialist sends the patient's records to the patient's partner.
◉ Which of the following terms refers to the difference between the
billing and allowed amounts? Answer: Adjustment
◉ Which of the following HMO managed care services requires a
referral? Answer: Durable medical equipment
,◉ Which of the following explains why Medicare will deny a
particular service or procedure? Answer: Advance Beneficiary
Notice (ABN)
◉ Which of the following types of claims is 120 days old? Answer:
Delinquent
◉ When reviewing an established patient's insurance card, the
billing and coding specialist notices a minor change from the
existing card on file. Which of the following actions should the
billing and coding specialist take? Answer: Photocopy both sides of
the new card
◉ A husband and wife each have group insurance through their
employers. The wife has an appointment with her provider. Which
insurance should be used as primary for the appointment? Answer:
The wife's insurance
◉ Which of the following would most likely result in a denial on a
Medicare claim? Answer: An experimental chemotherapy
medication for a patient who has stage III renal cancer
◉ Which of the following pieces of guarantor information is
required when establishing a patient's financial record? Answer:
Phone number
, ◉ A provider surgically punctures through the space between the
patient's ribs using an aspirating needle to withdraw fluid from the
chest cavity. Which of the following is the name of this procedure?
Answer: Pleurocentesis
◉ A patient has AARP as secondary insurance. In which of the
following blocks on the CMS-1500 claim form should the
information be entered? Answer: Block 9
◉ A Medicare non-participating (non-PAR) provider's approved
payment amount is $200 for a lobectomy and the deductible has
been met. Which of the following amounts is the limiting charge for
this procedure? Answer: $230
**A non-PAR who does not accept assignment, can collect a
maximum of 15% (the limiting charge) over the non-PAR Medicare
fee schedule amount.
◉ In the anesthesia section of the CPT manual, which of the
following are considered qualifying circumstances? Answer: Add-on
codes
◉ Threading a catheter with a balloon into a coronary artery and
expanding it to repair arteries describes which of the following
procedures? Answer: Angioplasty
