NHA CBCS CERTIFICATION Exam with Complete Solutions 2023\2024 Update, Exams of Nursing

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2023\2024 Update.

Which of the following is considered the final determination of the issues involving settlement of an insurance claim? - Answer Adjudication A form that contains charges, DOS, CPT codes, ICD codes, fees and copayment information is called which of the following? - Answer Encounter form A patient comes to the hospital for an inpatient procedure. Which of the following hospital staff members is responsible for the initial patient interview, obtaining demographic and insurance information, and documenting the chief complaint? - Answer Admitting clerk Which of the following privacy measures ensures protected health information (phi)? - Answer Using data encryption software on office workstations

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2023\2024 Update.

Which of the following planes divides the body into left and right? - Answer Sagittal Which of the following provisions ensures that an insured's benefits from all insurance companies do not exceed 100% of allowable medical expenses? - Answer Coordination of benefits Which of the following actions should be taken first when reviewing a delinquent claim? - Answer Verify the age of the account Which of the following is the advantage of electronic claim submission?

• Answer Claims are expedited

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2023\2024 Update.

Which of the following components of an explanation of benefits expedites the process of a phone appeal? - Answer Claim control number The standard medical abbreviation ECG refers to a test used to assess which of the following body systems? - Answer Cardiovascular system Which of the following actions by a billing and coding specialist would be considered fraud? - Answer Billing for services not provided The >< symbol is used to indicate a new and revised test other than which of the following? - Answer Procedure descriptors On the CMS-1500 claim form, blocks 14 through 33 contain information about which of the following? - Answer The patient's condition and the provider's information

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2023\2024 Update.

Which of the following includes procedures and best practices for correct coding? - Answer Coding Compliance Plan When completing a CMS-1500 paper claim form, which of the following is an acceptable action for the billing and coding specialist to take? - Answer Use arial size 10 font A participating blue cross/blue shield (BC/BS) provider receives an explanation of benefits for a patient account. The charged amount was $100. BC/BS allowed $80 and applied $40 to the patient's annual deductible. BC/BS paid the balance at 80%. How much should the patient expect to pay? - Answer $ Which of the following indicates a claim should be submitted on paper instead of electronically? - Answer The claim requires an attachment

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2023\2024 Update.

According to HIPAA standards, which of the following identifies the rendering provider on the CMS-1500 claim form in block 24j? - Answer NPI Which of the following blocks should the billing and coding specialist complete on the CMS-1500 claim form form for procedures, services or supplies (CPT/HCPCS)? - Answer Block 24D Which of the following terms describes when a plan pays 70% of the allowed amount and the patient pays 30%? - Answer Coinsurance A provider charged $500 to claim that had an allowable amount of $400. In which of the following columns should the billing and coding specialist apply the non-allowed charge? - Answer Adjustment column of the credits

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2023\2024 Update.

Which of the following is a HIPAA compliance guideline affecting electronic health records? - Answer The electronic transmission and code set standards require every provider to use the healthcare transactions ,code sets and identifiers Patient: Jane Austin; Social Security # 555-22-1111; Medicare ID: 555- 33-2222A; DOB: 05/22/1945. Claim information entered: Austin, Jane; Social Security #.: 555-22-1111; Medicare ID No.: 555-33-2222A; DOB:

52245. Which of the following is a reason this claim was rejected? - Answer The DOB is entered incorrectly Why does correct claim processing rely on accurately completed encounter forms? - Answer They streamline patient billing by summarizing the services rendered for a given date of service

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2023\2024 Update.

A patient's health plan is referred to as the "payer of last resort." The patient is covered by which of the following health plans? - Answer Medicaid Which of the following color formats is acceptable on the CMS- claim form? - Answer Red Which of the following is an example of a violation of an adult patient's confidentiality? - Answer Patient information was disclosed to the patient's parents without consent. In the anesthesia section of the CPT manual, which of the following are considered qualifying circumstances? - Answer Add-on codes Ambulatory surgery centers, home health care, and hospice organizations use the - Answer UB-04 claim form

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2023\2024 Update.

Which of the following is a private insurance carrier? - Answer Blue Cross/ Blue Shield Which of the following shows outstanding balances? - Answer Aging report Which of the following is one of the purposes of an internal auditing program in a physician's office? - Answer Verifying that the medical records and the billing record match The star symbol in the CPT code book is used to indicate which of the following? - Answer Telemedicine Medigap coverage is offered to Medicare beneficiaries by which of the following? - Answer Private third party payers

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2023\2024 Update.

A patient's portion of the bill should be discussed with the patient before a procedure is performed for which of the following reasons? - Answer To ensure the patient understands his portion of the bill The physician bills $500 to a patient. After submitting the claim to the insurance company, the claim is sent back with no payment. The patient still owes $500 for this year. This amount is called - Answer Deductible 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 designated 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.

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2023\2024 Update.

A patient is upset about a bill she received. Her insurance company denied the claim. Which of the following actions is an appropriate way to handle the situation? - Answer Inform the patient of the reason of the denial A patient presents to the provider with chest pain and SOB. After an unexpected ECG result, the provider calls a cardiologist and summarizes the patient's symptoms. What portion of HIPAA allows the provider to speak to the cardiologist prior to obtaining the patient's consent? - Answer TITLE II A physician ordered a comprehensive metabolic panel for a 70 year old patient who has Medicare as her primary insurance. Which of the following forms is required so the patient knows she may be responsible for payment? - Answer Advanced Beneficiary Notice

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2023\2024 Update.

Which of the following describes the reason for a claim rejection because of Medicare NCCI edits? - Answer Improper code combinations Which of the following is the purpose of running an aging report each month? - Answer It indicates which claims are outstanding Which of the following do physicians use to electronically submit claims? - Answer Clearinghouses Which of the following should the billing and coding specialist include in an authorization to release information? - Answer The entity to whom the information is to be released Which of the following information is required on a patient account record? - Answer Name and address of guarantor

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2023\2024 Update.

Which of the following forms should the billing and coding specialist transmit to the insurance carrier for reimbursement of inpatient hospital services? - Answer UB- An insurance claims register (aged insurance report) facilitates which of the following? - Answer Follow up of insurance claims by date When posting payment accurately, which of the following items should the billing and coding specialist include? - Answer Patient's responsibility Which of the following should the billing and coding specialist complete to be reimbursed for the provider's services? - Answer CMS-1500 claim form

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2023\2024 Update.

As of April 1st 2014, what is the maximum number of diagnosis that can be reported on the CMS-1500 claim form before a further claim is required? - Answer 12 Which of the following describes an obstruction of the urethra? - Answer Urethratresia Which of the following options is considered proper supportive documentation for reporting CPT and ICD codes for surgical procedures? - Answer Operative report Which of the following describes a delinquent claim? - Answer The claim is overdue for payment All dependents 10 year of age or older are required to have which of the following for TRICARE? - Answer Military identification

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2023\2024 Update.

Which of the following types of claims is 120 days old? - Answer Delinquent HIPAA transaction standards apply to which of the following entities? - Answer Health care clearinghouse Which of the following actions should be taken when a claim is billed for a level four office visit and paid at a level three? - Answer Submit an appeal to the carrier with supporting documentation When submitting a clean claim with a diagnosis of kidney stones, which of the following procedure names is correct? - Answer Nephrolithiasis All e-mail correspondence to a third party payer containing patients' protected health information (PHI) should be - Answer Encrypted

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2023\2024 Update.

The billing and coding specialist should divide the evaluation and management code by which of the following? - Answer Place of service In which of the following departments should a patient be seen for psoriasis? - Answer Dermatology A nurse is reviewing a patient's lab results prior to discharge and discovers an elevated glucose level. Which of the following health care providers should be altered before the nurse can proceed with discharge planning? - Answer The attending physician Which of the following actions should be taken if an insurance company denies a service as not medically necessary? - Answer Appeal the decision with a provider's report

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2023\2024 Update.

A billing and coding specialist should understand that the financial record source that is generated by a provider's office is called a - Answer patient ledger account Which of the following is used to code diseases, injuries, impairments, and other health related problems? - Answer International Classification of Disease (ICD) Threading a catheter with a balloon into a coronary artery and expanding it to repair arteries describes which of the following procedures? - Answer Angioplasty A coroner's autopsy is comprised of which of the following examinations? - Answer Gross examination

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2023\2024 Update.

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 Which of the following blocks requires the patient's authorization to release medical information to process a claim? - Answer Block 12 The unlisted codes can be found in which of the following locations in the CPT manual? - Answer Guidelines prior to each section Which of the following is the portion of the account balance the patient must pay after services are rendered and the annual deductible is met?

• Answer Coinsurance When coding on the UB-04 form, the billing and coding specialist must sequence the diagnosis codes according to the ICD guidelines. Which of

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2023\2024 Update.

the following is the first listed diagnosis code? - Answer Principal diagnosis Which of the following actions by the billing and coding specialists prevents fraud? - Answer Performing periodic audits Which of the following does a patient sign to allow payment of claims directly to the provider? - Answer Assignment of benefits Which of the following actions should the billing and coding specialist take if he observes a colleague in an unethical situation? - Answer Report the incident to a supervisor Which of the following is the purpose of precertification? - Answer Verification of coverage

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2023\2024 Update.

A provider performs an examination of a patient's throat during an office visit. Which of the following describes the level of the examination? - Answer Problem focused examination Which of the following is the verbal or written agreement that gives approval to some action, situation, or statement, and allows the release of patient information? - Answer Constant agreement A claim can be denied or rejected for which of the following reasons? - Answer Block 24D contains the diagnosis code On the CMS-1500 claim form, Blocks 1 through 13 include which of the following? - Answer The patient demographics To be compliant with HIPAA, which of the following positions should be assigned in each office? - Answer Privacy officer

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2023\2024 Update.

Which of the following information should the billing and coding specialist input into Block 33a on the CMS-1500 claim form? - Answer National provider identification number Which part of Medicare covers prescriptions? - Answer Part D Which of the following is the function of the respiratory system? - Answer Oxygenating blood cells Urine moves from the kidneys to the bladder through which of the following parts of the body? - Answer Ureters Claims that are submitted without an NPI number will delay payment to the provider because - Answer The number is needed to identify the provider

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2023\2024 Update.

Which of the following sections of the medical record is used to determine the correct Evaluation and Management code used for billing and coding? - Answer History and physical 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? - Answer Provider A dependent child whose parents both have insurance coverage comes to the clinic. The billing and coding specialist uses the birthday rule to determine which insurance policy is primary. Which of the following describes the birthday rule? - Answer The parent whose birthdate comes first in the calendar year

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2023\2024 Update.

Which of the following statements is correct regarding a deductible? - Answer The deductible is the patient's responsibility Which of the following claims is submitted and then optically scanned by the insurance carrier and converted to an electronic form? - Answer Paper claim A patient who has a primary malignant neoplasm of the lung should be referred to which of the following specialists? - Answer Pulmonary oncologist Which of the following statements is true regarding the release of patient records? - Answer Patient access to psychotherapy notes may be restricted

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2023\2024 Update.

Which of the following is the primary function of the heart? - Answer Pumping blood in the circulatory system A deductible of $100 is applied to a patient's remittance advice. The provider requests the account personnel write it off. Which of the following terms describes this scenario? - Answer Fraud A patient has AARP as secondary insurance. In which of the following blocks on the CMS-1500 claim form should this information be entered?

• Answer Block 9 A patient with a past due balance requests that his records be sent to another provider. Which of the following actions should be taken? - Answer Accommodate the request and send the records

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2023\2024 Update.

A claim is submitted with a transposed insurance member ID number and returned to the provider, which of the following describes the status that should be assigned to the claim by the carrier? - Answer Invalid Which of the following medical terms refers to the sac that encloses the heart? - Answer Pericardium A physician is contracted with an insurance company to accept the allowed amount. The insurance company allows $80 of a $120 billed amount, and $50 of the deductible has been met. How much should the physician write off the patient's account? - Answer $40 A billing and coding specialist is review a CMS-1500 claim form. The assignment of the benefits box has been checked yes. The check box indicates which of the following? - Answer The provider receives payment directly form the payer

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2023\2024 Update.

Which of the following describes the content of a medical practice aging report? - Answer an overview of the practices outstanding claims When a physician documents a patient's response to symptoms and various body systems, the results are documented as which of the following? - Answer Review of systems Medicare enforces mandatory submission of electronic claims for most providers. Which of the following providers is allowed to submit paper claims to medicare? - Answer A provider's office with fewer than 10 full time employees Which of the following is the correct term for an amount that has been determined to be uncollectible? - Answer Bad debt