CBCS NHA Exam 2026 – 100 Questions,
Answers & Explanations
SECTION 1: Insurance Basics
1. What type of insurance is considered the payer of last resort?
A. Medicare
B. Medicaid ✓
C. TRICARE
D. Workers’ Compensation
Explanation: Medicaid only pays after all other insurances have paid.
2. Which part of Medicare covers inpatient hospital services?
A. Medicare Part A ✓
B. Medicare Part B
C. Medicare Part C
D. Medicare Part D
Explanation: Part A = hospital/inpatient coverage.
3. Which insurance plan requires referrals from a PCP?
A. PPO
B. HDHP
C. HMO ✓
D. Medicaid
Explanation: HMOs require referrals to specialists.
4. What document verifies patient benefits before services?
,A. EOB
B. COB
C. Preauthorization
D. Eligibility check ✓
Explanation: Benefit/eligibility verification confirms coverage.
5. What is the term for the amount a patient must pay before insurance pays?
A. Premium
B. Copayment
C. Deductible ✓
D. Coinsurance
Explanation: Deductible = required amount before insurer pays.
6. Which program covers military service members and families?
A. Medicaid
B. TRICARE ✓
C. ChampVA
D. Medicare
Explanation: TRICARE is the military insurance program.
7. Coordination of Benefits (COB) prevents:
A. Denials
B. Double payments ✓
C. Coding errors
D. High deductibles
Explanation: COB ensures payers do not overpay.
8. The birthday rule determines primary insurance for:
A. Disabled workers
B. Spouses
C. Children with divorced parents
,D. Children with married parents ✓
Explanation: Parent with earlier birthday in the year is primary.
9. Medicare claims must be submitted within:
A. 30 days
B. 6 months
C. 12 months ✓
D. 24 months
Explanation: Medicare requires claims within one year.
10. What is Capitation?
A. Paying provider per visit
B. Paying provider per diagnosis
C. Paying provider per patient per month ✓
D. Paying provider fee-for-service
Explanation: Capitation = set monthly payment regardless of use.
SECTION 2: Coding (CPT, ICD-10, HCPCS)
11. ICD-10-CM codes are used for:
A. Procedures
B. Surgeries
C. Diagnoses ✓
D. Durable equipment
Explanation: ICD-10 diagnoses only.
12. CPT codes are used for:
A. Diagnoses
B. Drugs
C. Procedures ✓
, D. Facility fees
Explanation: CPT = procedure coding.
13. The first character of ICD-10 codes is always a:
A. Number
B. Letter ✓
C. Symbol
D. Modifier
Explanation: ICD-10 begins with a letter.
14. HCPCS Level II codes describe:
A. Surgeries
B. Physician services
C. Supplies and DME ✓
D. Diagnoses
Explanation: HCPCS = supplies, transport, equipment, injections.
15. Modifiers in CPT are:
A. Optional ICD codes
B. 2-digit updates ✓
C. Extra digits of HCPCS
D. Added procedures
Explanation: Modifiers explain procedure circumstances.
16. CPT 99213 belongs to which category?
A. Surgery
B. Radiology
C. Pathology
D. E/M services ✓
Explanation: Office visit established patient.
Answers & Explanations
SECTION 1: Insurance Basics
1. What type of insurance is considered the payer of last resort?
A. Medicare
B. Medicaid ✓
C. TRICARE
D. Workers’ Compensation
Explanation: Medicaid only pays after all other insurances have paid.
2. Which part of Medicare covers inpatient hospital services?
A. Medicare Part A ✓
B. Medicare Part B
C. Medicare Part C
D. Medicare Part D
Explanation: Part A = hospital/inpatient coverage.
3. Which insurance plan requires referrals from a PCP?
A. PPO
B. HDHP
C. HMO ✓
D. Medicaid
Explanation: HMOs require referrals to specialists.
4. What document verifies patient benefits before services?
,A. EOB
B. COB
C. Preauthorization
D. Eligibility check ✓
Explanation: Benefit/eligibility verification confirms coverage.
5. What is the term for the amount a patient must pay before insurance pays?
A. Premium
B. Copayment
C. Deductible ✓
D. Coinsurance
Explanation: Deductible = required amount before insurer pays.
6. Which program covers military service members and families?
A. Medicaid
B. TRICARE ✓
C. ChampVA
D. Medicare
Explanation: TRICARE is the military insurance program.
7. Coordination of Benefits (COB) prevents:
A. Denials
B. Double payments ✓
C. Coding errors
D. High deductibles
Explanation: COB ensures payers do not overpay.
8. The birthday rule determines primary insurance for:
A. Disabled workers
B. Spouses
C. Children with divorced parents
,D. Children with married parents ✓
Explanation: Parent with earlier birthday in the year is primary.
9. Medicare claims must be submitted within:
A. 30 days
B. 6 months
C. 12 months ✓
D. 24 months
Explanation: Medicare requires claims within one year.
10. What is Capitation?
A. Paying provider per visit
B. Paying provider per diagnosis
C. Paying provider per patient per month ✓
D. Paying provider fee-for-service
Explanation: Capitation = set monthly payment regardless of use.
SECTION 2: Coding (CPT, ICD-10, HCPCS)
11. ICD-10-CM codes are used for:
A. Procedures
B. Surgeries
C. Diagnoses ✓
D. Durable equipment
Explanation: ICD-10 diagnoses only.
12. CPT codes are used for:
A. Diagnoses
B. Drugs
C. Procedures ✓
, D. Facility fees
Explanation: CPT = procedure coding.
13. The first character of ICD-10 codes is always a:
A. Number
B. Letter ✓
C. Symbol
D. Modifier
Explanation: ICD-10 begins with a letter.
14. HCPCS Level II codes describe:
A. Surgeries
B. Physician services
C. Supplies and DME ✓
D. Diagnoses
Explanation: HCPCS = supplies, transport, equipment, injections.
15. Modifiers in CPT are:
A. Optional ICD codes
B. 2-digit updates ✓
C. Extra digits of HCPCS
D. Added procedures
Explanation: Modifiers explain procedure circumstances.
16. CPT 99213 belongs to which category?
A. Surgery
B. Radiology
C. Pathology
D. E/M services ✓
Explanation: Office visit established patient.
