NHA MEDICAL CODING AND BILLING
EXAM QUESTIONS WITH COMPLETE
ANSWERS
Authorization - Answer-Permission granted by the patient or the patient’s
representative to release information for reasons other than treatment, payment, or
health care operations
Reimbursment - Answer-Payment for services rendered from a 3rd Party Payer
Auditing - Answer-Review of claims for accuracy and completeness
Upcoding - Answer-Assigning a diagnosis or procedure code at a higher level than
the documentation supports, such as single code that describes all steps of the
procedure
Unbundling - Answer-Using multiple codes that describe different components of a
treatment instead of using a single code that describes all steps of the procedure
Fraud - Answer-Making false statements of representations of material facts to
obtain some benefit or payment for which no entitlement would otherwise exist
Abuse - Answer-Practices that directly or indirectly result in unnecessary cost to the
Medicare program
What is the Difference between Fraud and abuse? - Answer-Fraud is intentionally
misrepresenting services rendered for the purpose if receiving a higher payment.
Abuse refers to practices that are often done unknowingly as a result of poor
business practices, directly or indirectly resulting in unnecessary costs to the
program through improper payments.
What is the main job of the office inspector general?(OIG) - Answer-Protects
Medicare and other HHS programs from fraud and abuse by conducting audits,
investigations, and inspections
Timely filing requirment - Answer-Within 1 Calendar year of a claims date
Electronic data interchange (EDI) - Answer-The transfer of electronic information in a
standard format
Coordination of benefits rule - Answer-Determines which insurance plan is primary
and which is secondary insurance .
Conditional Payment - Answer-Medicare payment that is recovered after primary
insurance pays.
, Crossover claim - Answer-Claim submitted by people covered by primary and
secondary insurance plan
Two causes of a claim transmission errors - Answer-Missing or invalid patient
identification number and lack of authorization or referral number
Assignment of Benefits - Answer-Contract in which the provider directly bills the
payer and accepts the allowable charge.
Clean claim - Answer-Claim that is accurate and complete
Dirty claim - Answer-Claim that inaccurate, incomplete, or contains other errors
Medicare administrative Contractor (MAC) - Answer-Processes Medicare Parts A &
B claims from hospitals, physicians, and other providers
Remittance Advice (RA) - Answer-The report sent from the third-party payer to the
provider that reflects any changes made to the original billing.
2 Pieces of Information that need to be collected from patients - Answer-Patients
name and date of birth
Preauthorization form - Answer-Which of the following is a requirement of some
third-party payers before a procedure is performed?
Precertification - Answer-Ensure appropriate insurance coverage for an outpatient
procedure by first using the following process
History - Answer-Key component if an evaluation and management service
837 - Answer-Format used to submit electronic claims and 3rd Party payer
Office of the Inspector General (OIG) - Answer-Entity that defines the essential
element of a comprehensive compliance program
National Coverage Determination - Answer-Medicare Policy determines if a
particular item or service is covered
Left upper quadrant - Answer-Location of the stomach, spleen, part of the pancreas
and liver
18% - Answer-Coding a front torso burn, what % should be used?
An italicized code used as the 1st listed diagnosis - Answer-Result of a claim being
denied
Charging excessive fees - Answer-Example of Medicare abuse
Codes must correspond to the diagnosis pointer in block 24E - Answer-Diagnostic
codes in Block 21 of the CMS form
EXAM QUESTIONS WITH COMPLETE
ANSWERS
Authorization - Answer-Permission granted by the patient or the patient’s
representative to release information for reasons other than treatment, payment, or
health care operations
Reimbursment - Answer-Payment for services rendered from a 3rd Party Payer
Auditing - Answer-Review of claims for accuracy and completeness
Upcoding - Answer-Assigning a diagnosis or procedure code at a higher level than
the documentation supports, such as single code that describes all steps of the
procedure
Unbundling - Answer-Using multiple codes that describe different components of a
treatment instead of using a single code that describes all steps of the procedure
Fraud - Answer-Making false statements of representations of material facts to
obtain some benefit or payment for which no entitlement would otherwise exist
Abuse - Answer-Practices that directly or indirectly result in unnecessary cost to the
Medicare program
What is the Difference between Fraud and abuse? - Answer-Fraud is intentionally
misrepresenting services rendered for the purpose if receiving a higher payment.
Abuse refers to practices that are often done unknowingly as a result of poor
business practices, directly or indirectly resulting in unnecessary costs to the
program through improper payments.
What is the main job of the office inspector general?(OIG) - Answer-Protects
Medicare and other HHS programs from fraud and abuse by conducting audits,
investigations, and inspections
Timely filing requirment - Answer-Within 1 Calendar year of a claims date
Electronic data interchange (EDI) - Answer-The transfer of electronic information in a
standard format
Coordination of benefits rule - Answer-Determines which insurance plan is primary
and which is secondary insurance .
Conditional Payment - Answer-Medicare payment that is recovered after primary
insurance pays.
, Crossover claim - Answer-Claim submitted by people covered by primary and
secondary insurance plan
Two causes of a claim transmission errors - Answer-Missing or invalid patient
identification number and lack of authorization or referral number
Assignment of Benefits - Answer-Contract in which the provider directly bills the
payer and accepts the allowable charge.
Clean claim - Answer-Claim that is accurate and complete
Dirty claim - Answer-Claim that inaccurate, incomplete, or contains other errors
Medicare administrative Contractor (MAC) - Answer-Processes Medicare Parts A &
B claims from hospitals, physicians, and other providers
Remittance Advice (RA) - Answer-The report sent from the third-party payer to the
provider that reflects any changes made to the original billing.
2 Pieces of Information that need to be collected from patients - Answer-Patients
name and date of birth
Preauthorization form - Answer-Which of the following is a requirement of some
third-party payers before a procedure is performed?
Precertification - Answer-Ensure appropriate insurance coverage for an outpatient
procedure by first using the following process
History - Answer-Key component if an evaluation and management service
837 - Answer-Format used to submit electronic claims and 3rd Party payer
Office of the Inspector General (OIG) - Answer-Entity that defines the essential
element of a comprehensive compliance program
National Coverage Determination - Answer-Medicare Policy determines if a
particular item or service is covered
Left upper quadrant - Answer-Location of the stomach, spleen, part of the pancreas
and liver
18% - Answer-Coding a front torso burn, what % should be used?
An italicized code used as the 1st listed diagnosis - Answer-Result of a claim being
denied
Charging excessive fees - Answer-Example of Medicare abuse
Codes must correspond to the diagnosis pointer in block 24E - Answer-Diagnostic
codes in Block 21 of the CMS form
