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

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NHA CBCSExam(New2024/ 2025Update)|Questions and Verified Answers| 100%Correct|AGradeQUESTIONWhich of the following formats are used to submit electronic claims to a third-party payer?Answer:837QUESTIONUrine moved from the kidneys to the bladder through which of the following parts of the body?Answer:UretersQUESTIONAs of April 1, 2014, what is the maximum number of diagnoses that can be reported on theCMS-1500 claim form before a further claim is required?Answer:12QUESTIONWhich of the following does a patient sign to allow payment of claims directly to the provider?Answer:Assignment of benefitsQUESTION

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Which of the following is the primary function of the heart?Answer:Pumping blood in the circulatory systemQUESTIONWhich of the following is true regarding Medicaid eligibility?Answer:Patient eligibility is determined monthlyQUESTIONThe explanation of benefits states the amount billed was $80. The allowed amount is $60, andthe patient is required to pay a $20 copayment. Which of the following describes the insurancecheck amount to be posted?Answer:$40QUESTIONWhich of the following provisions ensures that an insured's benefits from all insurancecompanies do not exceed 100% of allowable medical expenses?Answer:Coordination of benefitsQUESTIONIf a clean claim is received on March 1 of this year, which of the following is the allowable lastday of payment in order to meet Medicare compliance requirements?Answer:March 30

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QUESTIONOn a remittance advice form, which of the following is responsible for writing off the differencebetween the amount billed and the amount allowed by the agreement?Answer:ProviderQUESTIONWhich of the following is the maximum number of modifiers that the billing and codingspecialist can report on a CMS-1500 claim form in Block 24D?Answer:4QUESTIONWhen the remittance advice is sent from the third-party payer to the provider, which of thefollowing actions should the billing and coding specialist perform first?Answer:Ensure proper payment has been madeQUESTIONWhich of the following is a reason a claim would be denied?Answer:Incorrectly linked codesQUESTIONThe billing and coding specialist should follow the guidelines in the CPT manual for which ofthe following reasons?

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Answer:The guidelines define items that are necessary to accurately codeQUESTIONWhich of the following documentation is a valid authorization to release medical information tothe judicial system?Answer:Subpoena duces tecumQUESTIONA claim is denied due to termination of coverage. Which of the following actions should thebilling and coding specialist take next?Answer:Follow up with the patient to determine current name, address, and insurance carrier forresubmissionQUESTIONA patient who has a primary malignant neoplasm of the lung should be referred to which of thefollowing specialists?Answer:Pulmonary oncologistQUESTIONWhich 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 healthcaretransactions, code sets, and identifiers

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QUESTIONWhich of the following options is considered proper supportive documentation for reportingCPT and ICD codes for surgical procedures?Answer:Operative reportQUESTIONWhich of the following blocks on the CMS-1500 claim form is used to accept assignment ofbenefits?Answer:Block 27QUESTIONWhich of the following is an example of a remark code from an explanation of benefitsdocument?Answer:Contractual allowanceQUESTIONWhich 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 claimQUESTIONThe unlisted codes can be found in which of the following locations in the CPT manual?

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Answer:Guidelines prior to each sectionQUESTIONWhich of the following privacy measures ensures protected health information (PHI)?Answer:Using data encryption software on office workstationsQUESTIONA physician's office fee is $100 and the Medicare Part B allowed is $85. Assuming thebeneficiary has not met his annual deductible, the office should bill the patient for which of thefollowing amounts?Answer:$85QUESTIONWhich of the following forms should the billing and coding specialist transmit to the insurancecarrier for reimbursement of inpatient hospital services?Answer:UB-04QUESTIONA patient has laboratory work done in the emergency department after an inhalation of toxicfumes from a faulty exhaust fan at her place of employment. Which of the following isresponsible for that charges?Answer:Worker's compensation

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QUESTIONA 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 provideridentifier (NPI) into which of the following blocks on the CMS-1500 claim form?Answer:Block 24JQUESTIONWhich of the following is included in the release of patient information?Answer:The date of the last disclosureQUESTIONWhich of the following describes a key component of an evaluation and management service?Answer:HistoryQUESTIONWhich of the following reports is used to arrange the accounts receivable from the date ofservice?Answer:Aging reportQUESTIONWhich of the following best describes medical ethics?

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Answer:Medical standard of conductQUESTIONA provider performs an examination of a patient's knee joint via small incisions and an opticaldevice. Which of the following terms describes this procedure?Answer:ArthroscopyQUESTIONWhich of the following accurately describes code symbols found in the CPT manual?Answer:A product pending FDA approval is indicated as a lightning-bolt symbolQUESTIONOn the CMS-1500 claim form, blocks 14 through 33 contain information about which of thefollowing?Answer:The patient's condition and the provider's informationQUESTIONWhich of the following describes an insurance carrier that pays the provider who renderedservices to a patient?Answer:Third-party payerQUESTION

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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 cancerQUESTIONWhich of the following pieces of guarantor information is required when establishing a patient'sfinancial record?Answer:Phone numberQUESTIONA provider surgically punctures through the space between the patient's ribs using an aspiratingneedle to withdraw fluid from the chest cavity. Which of the following is the name of thisprocedure?Answer:PleurocentesisQUESTIONA patient has AARP as secondary insurance. In which of the following blocks on the CMS-1500claim form should the information be entered?Answer:Block 9QUESTIONA Medicare non-participating (non-PAR) provider's approved payment amount is $200 for alobectomy and the deductible has been met. Which of the following amounts is the limitingcharge for this procedure?

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Answer:$230**A non-PAR who does not accept assignment, can collect a maximum of 15% (the limitingcharge) over the non-PAR Medicare fee schedule amount.QUESTIONIn the anesthesia section of the CPT manual, which of the following are considered qualifyingcircumstances?Answer:Add-on codesQUESTIONThreading a catheter with a balloon into a coronary artery and expanding it to repair arteriesdescribes which of the following procedures?Answer:AngioplastyQUESTIONWhich of the following actions by a billing and coding specialist would be considered fraud?Answer:Billing for services not providedQUESTIONWhich 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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QUESTIONWhich 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 CQUESTIONA billing and coding specialist can ensure appropriate insurance coverage for an outpatientprocedure by first using which of the following processes?Answer:Precertification**Precertification is the first step. Preauthorization is a decision from the payer to approve theservice. It is not the first step to determine insurance reimbursement.QUESTIONWhich of the following is considered fraud?Answer:The billing and coding specialist unbundles a code to receive higher reimbursementQUESTIONThe authorization number for a service that was approved before the service was rendered isindicated in which of the following blocks on the CMS-1500 claim form?Answer:Block 23QUESTIONA 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 withcoverage 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 authorizationQUESTIONWhich of the following symbols indicates a revised code?Answer:TriangleQUESTIONIf both parents have full coverage for a dependent child, which of the following is considered tobe the primary insurance holder?Answer:The parent whose birthdate comes first in the calendar year is the primary insurance holderQUESTIONWhich of the following entities defines the essential elements of a comprehensive complianceprogram?Answer:Office of Inspector General (OIG)QUESTIONThe >< symbol is used to indicate new and revised text other than which of the following?Answer:Procedure descriptors

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QUESTIONWhich of the following describes the organization of an aging report?Answer:By dateQUESTIONWhich of the following is the purpose of coordination of benefits?Answer:Prevent multiple insurers from paying benefits covered by other policiesQUESTIONA billing and coding specialist submitted a claim to Medicare electronically. No errors werefound by the billing software or clearinghouse. Which of the following describes this claim?Answer:Clean claimQUESTIONWhich of the following qualifies as an exception to the HIPAA Privacy Rule?Answer:Psychotherapy notesQUESTIONWhich of the following would result in a claim being denied?Answer:An italicized code used as the first listed diagnosis

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QUESTIONWhich of the following standardized formats are used in the electronic filing of claims?Answer:HIPAA standard transactionsQUESTIONWhich of the following describes a two-digit CPT code used to indicate that the providersupervised an interpreted a radiology procedure?Answer:Professional componentQUESTIONIn 1996, CMS implemented which of the following to detect inappropriate and improper codes?Answer:National Correct Code Initiative (NCCI)QUESTIONWhich of the following prohibits a provider from referring Medicare patients to a clinicallaboratory service in which of the provider has a financial interest?Answer:Stark LawQUESTIONWhich of the following sections of the SOAP note indicates a patient's level of pain to aprovider?Answer:

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