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

Download NHA CBCS Exam 2024 Expected Questions with Verified Answers and more Exams Natural Language Processing (NLP) in PDF only on Docsity! 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 >>>>12 months from the date of service 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 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 B12 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 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 >>>>837 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 >>>>12 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 >>>>$40 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 >>>>4 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 >>>>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 >>>>$85 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 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 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? - ....ANSWER >>>>Inform the patient of the reason for the denial A patient with a past due balance requests that his records be sent to another provider. What action should be taken? - ....ANSWER >>>>Accommodate the request and send the records 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 the year. This amount is called? - ....ANSWER >>>>Deductible A physician ordered a comprehensive metabolic panel for a 70-year-old patient who has Medicare as her primary insurance. This form is required so the patient knows she may be responsible for payment? - ....ANSWER >>>>Advance Beneficiary Notice A provider charged $500 to a 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 Sections of the medical record used to determine the correct Evaluation and Management code used for billing and coding? - ....ANSWER >>>>History and Physical The symbol "O" in the Current Procedural Terminology reference is used to indicate which of the following? - ....ANSWER >>>>Reinstate or recycled code This block requires the patient's authorization to release medical information to process a claim? - ....ANSWER >>>>Block 12 This describes an obstruction of the urethra? - ....ANSWER >>>>Urethratresia This includes procedures and best practices for correct coding? - ....ANSWER >>>>Coding Compliance Plan What information should the billing and coding specialist input in Block 33a on the CMS-1500 claim form? - ....ANSWER >>>>National Provider Identification Number What is considered the final determination of the issues involving settlement of an insurance claim? - ....ANSWER >>>>Adjudication What is the advantage of electronic claim submission? - ....ANSWER >>>>Claims are expedited What is the purpose of precertification? - ....ANSWER >>>>Verification of coverage What shows outstanding balances? - ....ANSWER >>>>Aging report What terms describes when a plan pays 70% of the allowed amount and the patient pays 30%? - ....ANSWER >>>>Coinsurance When coding on the UB-04 form, the billing and coding specialist must sequence the diagnosis codes according to ICD guidelines. Which of the following is the first listed diagnosis code? - ....ANSWER >>>>Patient's responsibility When submitting a clean claim with a diagnosis of kidney stones, the name of the procedure is? - ....ANSWER >>>>Nephrolithiasis 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 Accepting assignment on the CMS-1500 claim form indicates that - ....ANSWER >>>>the physician agrees to accept payment under the terms of the payers program After a third-party payer validates a claim, which of the following takes place next? - ....ANSWER >>>>Claim adjudication A beneficiary of a Medicare/Medicaid crossover claim submitted by a participating provider is responsible for which of the following percentages? - ....ANSWER >>>>0% A billing and coding specialist can ensure appropriate insurance coverage for an outpatient procedure by first using which of the following processes? - ....ANSWER >>>>Precertification A billing and coding specialist has four past do payments, which one goes to collections first? - ....ANSWER >>>>The largest past-due charge A billing and coding specialist is reviewing a CMS-1500 claim form. The "assignment of benefits box has been checked yes. The checked box indicates which of the following? - ....ANSWER >>>>The provider receives payment directly from the payer Block 17b on the CMS-1500 claim form - ....ANSWER >>>>referring physicians NPI NPI for referring provider is in block - ....ANSWER >>>>17b 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 prospective billing account audit prevents fraud by reviewing and comparing a completed claim form with which of the following documents? - ....ANSWER >>>>A billing worksheet from the patients account A provider receives a reimbursement from a third-party payer accompanied by which of the following documents? - ....ANSWER >>>>EOB Rendering provider's NPI is in block - ....ANSWER >>>>24J The symbol for exemptions to modifier 51 - ....ANSWER >>>>circle with a slash through it A participating BCBS provider received an EOB for a patient account. The charged amount was $100. BCBS allowed $80 and applied $40 to the patients annual deductible. BCBS paid the balance at 80%. How much should the patient expect to pay? - ....ANSWER >>>>48 Symbol for out of numerical sequence code is - ....ANSWER >>>># A physician is contacted with an insurance company to accept the allowed amount. The insurance company allows $80 of a $120 bill and $50 of the deductible has not been met. How much should the physician write off the patients account? - ....ANSWER >>>>$40 Symbol for telemedicine is a - ....ANSWER >>>>star A physician's office fee is $100 and the Medicare Part B allowed amount is $85. Assuming the beneficiary has not met his annual deductible, the office should bill the patient for what amount? - ....ANSWER >>>>$85 What accurately describes code symbols found in the CPT manual? - ....ANSWER >>>>A product pending FDA approval is indicated as a lightning- bolt symbol When a patient has a condition that is both acute and chronic, how should it be reported? - ....ANSWER >>>>Code both acute and chronic, sequencing the acute first When submitting claims, which of the following is the outcome if block 13 is left blank? - ....ANSWER >>>>The third party payer reimburses the patient and the patient is responsible for reimbursing the provider Which format is used to submit claims electronically to a third party payer? - ....ANSWER >>>>837 Which of the following billing patterns is a best- practice action? - ....ANSWER >>>>Documenting the patients chief complaint, history, exam, assessment and plan for care Which symbol indicates an add on code? - ....ANSWER >>>>Plus sign Which symbol indicates a new code? - ....ANSWER >>>>Bullet Z codes are used to identify - ....ANSWER >>>>Immunizations A triangle (🞁) represents? - ....ANSWER >>>>A change in the code description since the last edition What does two triangular symbols (⧓) represent? - ....ANSWER >>>>Changes in the text or definition between the triangles What does a bullet (∙) represent? - ....ANSWER >>>>A new procedure or service code added since the previous edition of the manual The patient's birth date on the CMS-1500 claim form is entered in what format? - ....ANSWER >>>>MM/DD/YYYY Temporary codes for drugs and medical equipment are what type of HCPCS codes? - ....ANSWER >>>>Q codes Which of the following modifiers should be used to indicate a professional service has been discontinued prior to completion? - ....ANSWER >>>>-53 Which of the following modifiers should be used to indicate a discontinued outpatient procedure prior to anesthesia administration? - ....ANSWER >>>>-73 Which of the following modifiers should be used to indicate that a service code was reduced from its original description? - ....ANSWER >>>>-52 Which of the following modifiers should be used to indicate a discontinued outpatient procedure after anesthesia administration? - ....ANSWER >>>>-74 A coding specialist should use which modifier to report a bilateral procedure? - ....ANSWER >>>>- 50 A coding specialist should use which modifier to report multiple procedures? - ....ANSWER >>>>-51 A coding specialist should use which modifier to report reduced services? - ....ANSWER >>>>-52 What are the three key components of an E/M code? - ....ANSWER >>>>History, examination, and medical decision making What is a pre-existing condition? - ....ANSWER >>>>An illness or condition present before insurance coverage begins A new patient is: - ....ANSWER >>>>One who has not visited the physician in more than 3 years A patient is diagnosed with metastatic bone neoplasm. The neoplasms will be coded as? - ....ANSWER >>>>Secondary malignant The department of ________________________________ refers patients to a specialty department for further treatment - ....ANSWER >>>>Internal/Family Medicine Define prefix Hypo- - ....ANSWER >>>>Below, deficient What is a precertification? - ....ANSWER >>>>A review that looks at whether the procedure could be performed safely but less expensively in an outpatient setting. What are Category I CPT Codes? - ....ANSWER >>>>Physician services and hospital outpatient coding Aging Reports are maintained in ________ increments - ....ANSWER >>>>30 day Explain the parts of Medicare A, B, C, and D - ....ANSWER >>>>A - Hospitalization/Inpatient B - Outpatient/Physician/Professional Services C - Medicare Advantage Plans D - Drug Coverage What does Block 13 on the CMS 1500 claim form indicate? - ....ANSWER >>>>The signature of the patient authorizing the payment of benefits to the provider/supplier What does Coordination of Benefits mean? - ....ANSWER >>>>Determines which insurance plan is primary and which is secondary What does the Fair Debt Collection Practices Act say debt collectors can't do? - ....ANSWER >>>>Use unfair or abusive practices to collect a debt What is a deductible? - ....ANSWER >>>>a specified amount of money that the insured must pay before an insurance company will pay a claim What is the difference between Medial and Lateral? - ....ANSWER >>>>Medial - Middle of the body Lateral - To the side What is PHI? - ....ANSWER >>>>Protected Health Information What is the location method in reference to the CPT book? - ....ANSWER >>>>Procedure or service Just anatomic site Condition or disease Synonym, eponym, or abbreviation What is the Stark Law? - ....ANSWER >>>>Prohibits a physician from referring patients for certain designated health services (Medicare & Medicaid) to entities with whom the physician has a financial relationship What is the timely filing limitation for Medicare? - ....ANSWER >>>>1 year What does Block 12 on the CMS-1500 form indicate? - ....ANSWER >>>>Patient's signature authorizing the release of medical information to the insurance company in order to process the claim. Implied consent is when the patient voluntarily undergoes treatment, such as extending your arm for venipuncture. What is the difference between transverse and sagittal? - ....ANSWER >>>>Transverse divides the body into top and bottom sections Sagittal divides the body into right and left sides ____________________________________ have finished medical school and their internship and are currently receiving training in a specialized area - ....ANSWER >>>>Resident Physician What is a CDM? - ....ANSWER >>>>Charge Description Master - has all of the information about health care services that a patient has received and financial transactions that have taken place. Define Morbidity - ....ANSWER >>>>The number of cases of disease in a specific population What is predetermination? - ....ANSWER >>>>A written request for a verification of benefits. What is the SCHIP program? - ....ANSWER >>>>State Childrens Health Insurance Program - State and federally funded program for low income families that do not qualify for Medicaid What is copayment? - ....ANSWER >>>>A fixed dollar amount that each patient pays for each office visit Define suffix -stomy - ....ANSWER >>>>Opening What are the Category III CPT Codes? - ....ANSWER >>>>Temporary coding for new technology and services that have not met the requirements needed to be added to the main section of the CPT book What information is requested upon arrival at a hospital, provider's office, or facility? - ....ANSWER >>>>Demographics -Name -Date of Birth -Gender -Last 4 of SSN What does assignment of benefits mean? - ....ANSWER >>>>Arrangement by which a patient requests that the payment be made directly to the provider Explain the difference between fraud and abuse? - ....ANSWER >>>>Fraud - intentionally misrepresenting services rendered for the purpose of 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 difference between Medicare and Medicaid? - ....ANSWER >>>>Medicare is federally funded and administered health insurance provided to people age 65 and older, people with certain disabilities, and ESRD Medicaid is a government based health insurance for individuals who have low-income and limited financial resources. Funded at the state and federal level but administered at the state level.