2024-2025 NHA CBCS Exam with Answers (222 Solved Questions)

Name: 2024-2025 NHA CBCS Exam with Answers (222 Solved Questions)
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NHA CBCS Exam (New 2024/ 2025 Update) |
Questions and Verified Answers| 100%
Correct| A Grade
QUESTION
Which of the following formats are used to submit electronic claims to a third-party payer?
Answer:
837
QUESTION
Urine moved from the kidneys to the bladder through which of the following parts of the body?
Answer:
Ureters
QUESTION
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
QUESTION
Which of the following does a patient sign to allow payment of claims directly to the provider?
Answer:
Assignment of benefits
QUESTION

Which of the following is the primary function of the heart?
Answer:
Pumping blood in the circulatory system
QUESTION
Which of the following is true regarding Medicaid eligibility?
Answer:
Patient eligibility is determined monthly
QUESTION
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
QUESTION
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
QUESTION
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

QUESTION
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
QUESTION
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
QUESTION
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
QUESTION
Which of the following is a reason a claim would be denied?
Answer:
Incorrectly linked codes
QUESTION
The billing and coding specialist should follow the guidelines in the CPT manual for which of
the following reasons?

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Answer:
The guidelines define items that are necessary to accurately code
QUESTION
Which of the following documentation is a valid authorization to release medical information to
the judicial system?
Answer:
Subpoena duces tecum
QUESTION
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
QUESTION
A patient who has a primary malignant neoplasm of the lung should be referred to which of the
following specialists?
Answer:
Pulmonary oncologist
QUESTION
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

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QUESTION
Which of the following options is considered proper supportive documentation for reporting
CPT and ICD codes for surgical procedures?
Answer:
Operative report
QUESTION
Which of the following blocks on the CMS-1500 claim form is used to accept assignment of
benefits?
Answer:
Block 27
QUESTION
Which of the following is an example of a remark code from an explanation of benefits
document?
Answer:
Contractual allowance
QUESTION
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
QUESTION
The unlisted codes can be found in which of the following locations in the CPT manual?

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Answer:
Guidelines prior to each section
QUESTION
Which of the following privacy measures ensures protected health information (PHI)?
Answer:
Using data encryption software on office workstations
QUESTION
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
QUESTION
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
QUESTION
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

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QUESTION
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
QUESTION
Which of the following is included in the release of patient information?
Answer:
The date of the last disclosure
QUESTION
Which of the following describes a key component of an evaluation and management service?
Answer:
History
QUESTION
Which of the following reports is used to arrange the accounts receivable from the date of
service?
Answer:
Aging report
QUESTION
Which of the following best describes medical ethics?

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Answer:
Medical standard of conduct
QUESTION
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
QUESTION
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
QUESTION
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
QUESTION
Which of the following describes an insurance carrier that pays the provider who rendered
services to a patient?
Answer:
Third-party payer
QUESTION

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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
QUESTION
Which of the following pieces of guarantor information is required when establishing a patient's
financial record?
Answer:
Phone number
QUESTION
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
QUESTION
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
QUESTION
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?

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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.
QUESTION
In the anesthesia section of the CPT manual, which of the following are considered qualifying
circumstances?
Answer:
Add-on codes
QUESTION
Threading a catheter with a balloon into a coronary artery and expanding it to repair arteries
describes which of the following procedures?
Answer:
Angioplasty
QUESTION
Which of the following actions by a billing and coding specialist would be considered fraud?
Answer:
Billing for services not provided
QUESTION
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

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QUESTION
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
QUESTION
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.
QUESTION
Which of the following is considered fraud?
Answer:
The billing and coding specialist unbundles a code to receive higher reimbursement
QUESTION
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
QUESTION
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?

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Answer:
The provider should contact the patient's insurance carrier to obtain a new authorization
QUESTION
Which of the following symbols indicates a revised code?
Answer:
Triangle
QUESTION
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
QUESTION
Which of the following entities defines the essential elements of a comprehensive compliance
program?
Answer:
Office of Inspector General (OIG)
QUESTION
The >< symbol is used to indicate new and revised text other than which of the following?
Answer:
Procedure descriptors

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QUESTION
Which of the following describes the organization of an aging report?
Answer:
By date
QUESTION
Which of the following is the purpose of coordination of benefits?
Answer:
Prevent multiple insurers from paying benefits covered by other policies
QUESTION
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
QUESTION
Which of the following qualifies as an exception to the HIPAA Privacy Rule?
Answer:
Psychotherapy notes
QUESTION
Which of the following would result in a claim being denied?
Answer:
An italicized code used as the first listed diagnosis

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QUESTION
Which of the following standardized formats are used in the electronic filing of claims?
Answer:
HIPAA standard transactions
QUESTION
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
QUESTION
In 1996, CMS implemented which of the following to detect inappropriate and improper codes?
Answer:
National Correct Code Initiative (NCCI)
QUESTION
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
QUESTION
Which of the following sections of the SOAP note indicates a patient's level of pain to a
provider?
Answer:

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Subject

National Healthcare Association