NHA CBCS Exam 2024 Expected Questions with Verified Answers, Exams of Natural Language Processing (NLP)

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NHA CBCS EXAM 2024 EXPECTED QUESTIONS

WITH VERIFIED ANSWERS GUARANTEE PASS

GRADED A

Which of the following Medicare policies determines if a particular item or service is covered by Medicare? - ....ANSWER >>>>National Coverage Determination (NCD) 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 >>>> 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 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 >>>> 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 $200 for a lobectomy and the deductible has been met. Which of the following amounts is the limiting charge for this procedure? - ....ANSWER >>>>$ **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 Which of the following actions by a billing and coding specialist would be considered fraud? - ....ANSWER >>>>Billing for services not provided Which of the following statements is accurate regarding the diagnostic codes in Block 21? - ....ANSWER >>>>These codes must correspond to the diagnosis pointer in Block 24E Which of the following parts of the Medicare insurance program is managed by private, third- party insurance providers that have been approved by Medicare? - ....ANSWER

Medicare Part C

A billing and coding specialist can ensure appropriate insurance coverage for an outpatient procedure by first using which of the following processes? - ....ANSWER >>>>Precertification **Precertification is the first step. Preauthorization is a decision from the payer to approve the service. It is not the first step to determine insurance reimbursement. Which of the following is considered fraud? - ....ANSWER >>>>The billing and coding specialist unbundles a code to receive higher reimbursement The authorization number for a service that was approved before the service was rendered is indicated in which of the following blocks on the CMS-1500 claim form? - ....ANSWER >>>>Block 23 A patient is preauthorized to receive vitamin B injections from Jan 1 to May 31. On June 2, the provider orders an additional 6 months of injections. In order for the patient to continue with coverage of care, which of the following should occur? - ....ANSWER >>>>The provider

should contact the patient's insurance carrier to obtain a new authorization Which of the following symbols indicates a revised code? - ....ANSWER >>>>Triangle If both parents have full coverage for a dependent child, which of the following is considered to be the primary insurance holder? - ....ANSWER >>>>The parent whose birthdate comes first in the calendar year is the primary insurance holder Which of the following entities defines the essential elements of a comprehensive compliance program? - ....ANSWER >>>>Office of Inspector General (OIG) The >< symbol is used to indicate new and revised text other than which of the following? - ....ANSWER >>>>Procedure descriptors Which of the following describes the organization of an aging report? - ....ANSWER >>>>By date

Which of the following is the purpose of coordination of benefits? - ....ANSWER

Prevent multiple insurers from paying benefits covered by other policies A billing and coding specialist submitted a claim to Medicare electronically. No errors were found by the billing software or clearinghouse. Which of the following describes this claim? - ....ANSWER Clean claim Which of the following qualifies as an exception to the HIPAA Privacy Rule? - ....ANSWER Psychotherapy notes Which of the following would result in a claim being denied? - ....ANSWER >>>>An italicized code used as the first listed diagnosis Which of the following standardized formats are used in the electronic filing of claims? - ....ANSWER >>>>HIPAA standard transactions Which of the following describes a two-digit CPT code used to indicate that the provider

supervised an interpreted a radiology procedure?

• ....ANSWER >>>>Professional component Which of the following formats are used to submit electronic claims to a third-party payer? - ....ANSWER >>>> Urine moved from the kidneys to the bladder through which of the following parts of the body?
• ....ANSWER >>>>Ureters As of April 1, 2014, what is the maximum number of diagnoses that can be reported on the CMS- 1500 claim form before a further claim is required? - ....ANSWER >>>> 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 is the primary function of the heart? - ....ANSWER >>>>Pumping blood in the circulatory system

Which of the following is true regarding Medicaid eligibility? - ....ANSWER >>>>Patient eligibility is determined monthly The explanation of benefits states the amount billed was $80. The allowed amount is $60, and the patient is required to pay a $20 copayment. Which of the following describes the insurance check amount to be posted? - ....ANSWER >>>>$ 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 If a clean claim is received on March 1 of this year, which of the following is the allowable last day of payment in order to meet Medicare compliance requirements? - ....ANSWER

March 30 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 Which of the following is the maximum number of modifiers that the billing and coding specialist can report on a CMS-1500 claim form in Block 24D? - ....ANSWER >>>> When the remittance advice is sent from the third-party payer to the provider, which of the following actions should the billing and coding specialist perform first? - ....ANSWER >>>>Ensure proper payment has been made Which of the following is a reason a claim would be denied? - ....ANSWER >>>>Incorrectly linked codes The billing and coding specialist should follow the guidelines in the CPT manual for which of the following reasons? - ....ANSWER >>>>The guidelines define items that are necessary to accurately code

Which of the following documentation is a valid authorization to release medical information to the judicial system? - ....ANSWER >>>>Subpoena duces tecum A claim is denied due to termination of coverage. Which of the following actions should the billing and coding specialist take next? - ....ANSWER

Follow up with the patient to determine current name, address, and insurance carrier for resubmission 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 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

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 blocks on the CMS- 1500 claim form is used to accept assignment of benefits? - ....ANSWER >>>>Block 27 Which of the following is an example of a remark code from an explanation of benefits document? - ....ANSWER >>>>Contractual allowance Which of the following describes the term "crossover" as it relates to Medicare? - ....ANSWER >>>>When an insurance company transfers data to allow coordination of benefits of a claim 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 privacy measures ensures protected health information (PHI)? - ....ANSWER

Using data encryption software on office workstations A physician's office fee is $100 and the Medicare Part B allowed is $85. Assuming the beneficiary has not met his annual deductible, the office should bill the patient for which of the following amounts? - ....ANSWER >>>>$ Which of the following forms should the billing and coding specialist transmit to the insurance carrier for reimbursement of inpatient hospital services? - ....ANSWER >>>>UB- 04 A patient has laboratory work done in the emergency department after an inhalation of toxic fumes from a faulty exhaust fan at her place of employment. Which of the following is Operative report Which of the following blocks on the CMS- 1500 claim form is used to accept assignment of benefits? - ....ANSWER >>>>Block 27 Which of the following is an example of a remark code from an explanation of benefits document? - ....ANSWER >>>>Contractual allowance Which of the following describes the term "crossover" as it relates to Medicare? - ....ANSWER >>>>When an insurance company transfers data to allow coordination of benefits of a claim 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 privacy measures ensures protected health information (PHI)? - ....ANSWER >>>>Using data encryption software on office workstations A physician's office fee is $100 and the Medicare Part B allowed is $85. Assuming the beneficiary has not met his annual deductible, the office should bill the patient for which of the following amounts? - ....ANSWER >>>>$ Which of the following forms should the billing and coding specialist transmit to the insurance carrier for reimbursement of inpatient hospital services? - ....ANSWER >>>>UB- 04 A patient has laboratory work done in the emergency department after an inhalation of toxic fumes from a faulty exhaust fan at her place of employment. Which of the following is responsible for that charges? - ....ANSWER Worker's compensation A billing and coding specialist is preparing a claim form for a provider from a group practice. The billing and coding specialist should enter the rendering provider's national provider identifier

(NPI) into which of the following blocks on the CMS-1500 claim form? - ....ANSWER >>>>Block 24J Which of the following is included in the release of patient information? - ....ANSWER >>>>The date of the last disclosure Which of the following describes a key component of an evaluation and management service? - ....ANSWER >>>>History Which of the following reports is used to arrange the accounts receivable from the date of service?

• ....ANSWER >>>>Aging report Which of the following best describes medical ethics? - ....ANSWER >>>>Medical standard of conduct A provider performs an examination of a patient's knee joint via small incisions and an optical device. Which of the following terms describes this procedure? - ....ANSWER >>>>Arthroscopy

Which of the following accurately describes code symbols found in the CPT manual? - ....ANSWER

A product pending FDA approval is indicated as a lightning-bolt symbol 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 Which of the following describes an insurance carrier that pays the provider who rendered services to a patient? - ....ANSWER >>>>Third- party payer In 1996, CMS implemented which of the following to detect inappropriate and improper codes? - ....ANSWER >>>>National Correct Code Initiative (NCCI) Which of the following prohibits a provider from referring Medicare patients to a clinical laboratory service in which of the provider has a financial interest? - ....ANSWER >>>>Stark Law

Which of the following sections of the SOAP note indicates a patient's level of pain to a provider? - ....ANSWER >>>>Subjective Which of the following planes divides the body into left and right? - ....ANSWER >>>>Sagittal Which of the following electronic forms is used to post payments? - ....ANSWER >>>>Electronic remittance advice (ERA) The explanation of benefits states the amount billed was $170. However, the allowed amount is $150. The patient has an unmet deductible of $50.00 and a copayment of $20. Which of the following amounts is the patient's responsibility?

• ....ANSWER >>>>$ Which of the following is a federal government health insurance program? - ....ANSWER

TRICARE For non-crossover claims, the billing and coding specialist should prepare an additional claim for The patient's condition and the provider's information Which of the following describes an insurance carrier that pays the provider who rendered services to a patient? - ....ANSWER >>>>Third- party payer In 1996, CMS implemented which of the following to detect inappropriate and improper codes? - ....ANSWER >>>>National Correct Code Initiative (NCCI) Which of the following prohibits a provider from referring Medicare patients to a clinical laboratory service in which of the provider has a financial interest? - ....ANSWER >>>>Stark Law Which of the following sections of the SOAP note indicates a patient's level of pain to a provider? - ....ANSWER >>>>Subjective Which of the following planes divides the body into left and right? - ....ANSWER >>>>Sagittal Which of the following electronic forms is used to post payments? - ....ANSWER >>>>Electronic remittance advice (ERA) The explanation of benefits states the amount billed was $170. However, the allowed amount is $150. The patient has an unmet deductible of $50.00 and a copayment of $20. Which of the following amounts is the patient's responsibility? - ....ANSWER >>>>$ Which of the following is a federal government health insurance program? - ....ANSWER >>>>TRICARE For non-crossover claims, the billing and coding specialist should prepare an additional claim for the secondary payer and send it with a copy of

which of the following? - ....ANSWER

Remittance advice Which of the following actions by the billing and coding specialist prevents fraud? - ....ANSWER Performing periodic audits When doing a front torso burn, which of the following percentages should be coded? - ....ANSWER >>>>18% Which of the following blocks should the billing and coding specialist complete on the CMS- 1500 claim form for procedures, services, or supplies?

• ....ANSWER >>>>Block 24D Which of the following blocks of the CMS- 1500 claim form indicates an ICD diagnosis code? - ....ANSWER >>>>Block 21 Which of the following national provider identifiers (NPIs) is required in Block 33a of a CMS-1500 claim form? - ....ANSWER >>>>Billing provider

Which of the following causes a claim to be suspended? - ....ANSWER >>>>Services require additional information Which of the following terms is used to describe the location of the stomach, the spleen, part of the pancreas, part of the liver, and part of the small and large intestines? - ....ANSWER >>>>Left upper quadrant Which of the following terms is used to describe the location of the right lobe of the liver, the gallbladder, part of the pancreas, and part of the small and large intestine? - ....ANSWER >>>>Right upper quadrant Which of the following terms is used to describe the location of the small and large intestine, the appendix, and the right ureter? - ....ANSWER

Right lower quadrant Which of the following terms is used to describe the location of the small and large intestines and the left ureter? - ....ANSWER >>>>Left lower qaudrant

Which of the following actions should the billing and coding specialist take when submitting a claim to Medicaid for a patient who has primary and secondary insurance coverage? - ....ANSWER

Attach the remittance advice from the primary insurance along with the Medicaid claim A billing and coding specialist has four past-due charges: $400 that is 10 weeks past due; $800 that is 6 weeks past due; $1,000 that is 4 weeks past due; and $2,000 that is 8 weeks past due. Which of the following charges should be sent to collections first? - ....ANSWER >>>>$2,000 In which of the following blocks on the CMS- 1500 claim form should the billing and coding specialist enter the referring provider's national provider identifier (NPI)? - ....ANSWER >>>>Block 17b When a third-party payer requests copies of patient information related to a claim, the billing and coding specialist must make sure which of the following is included in the patient's file? -

....ANSWER >>>>Signed release of information form A patient who has an HMO insurance plan needs to see a specialist for a specific problem. From which of the following should the patient obtain a referral? - ....ANSWER >>>>Primary care provider Which of the following organizations fights waste, fraud, and abuse in Medicare and Medicaid? - ....ANSWER >>>>Office of Inspector General (OIG) Which of the following is used to code diseases, injuries, impairments, and other health-related problems? - ....ANSWER >>>>International Classification of Diseases (ICD) Actions should be taken if an insurance company denies a service as not medically necessary? - ....ANSWER >>>>Appeal the decision with a provider's report The 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 the supporting documentation All dependents 10 years of age or older are required to have a military identification card for TRICARE? - ....ANSWER >>>>Military identification All e-mail correspondence to a third-party payer containing patient's protected health information (PHI) should be? - ....ANSWER >>>>Encrypted Ambulatory surgery center, home health care, and hospice organizations use the? - ....ANSWER

UB-04 claim form 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 What component of an explanation of benefits expedites the process of a phone appeal? - ....ANSWER >>>>Claim control number

A coroner's autopsy is comprised of which examination? - ....ANSWER >>>>Gross examination What do physician's used to electronically submit claims? - ....ANSWER >>>>Clearinghouse A form that contains charges, DOS, CPT codes, ICD- 10 - CM, fees, and copayment information is a?

• ....ANSWER >>>>Encounter form The function of the respiratory system? - ....ANSWER >>>>Oxygenating blood cells What medical term refers to the sac that enclosed the heart? - ....ANSWER >>>>Pericardium Medigap coverage is offered to Medicare beneficiaries by? - ....ANSWER >>>>Private third- party payers 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

On the CMS-1500 claim form, Block 1 through 13 include? - ....ANSWER >>>>The patient's demographics A patient presents to the provider with chest pain and shortness of breath. 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 patient's employer has not submitted a premium payment. What claim status should the provider receive from the third-party payer? - ....ANSWER >>>>Denied A patient's health plan is referred to as the "payer of last resort." The patient is covered what health plan? - ....ANSWER >>>>Medicaid A patient's upset about a bill she received. Her insurance company denied the claim. What action is an appropriate way to handle the situation? -