NHA CBCS PRACTICE TEST Questions and Answers Latest (2024 / 2025) (100% Verified Answers by Expert)
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Splinting of the fourth digit on the left foot A billing and coding specialist is reviewing modifier use with a new employee. Which of the following scenarios warrants the use of a modifier?
Patient access to psychotherapy notes is restricted Which of the following statements is true regarding the release of patient records?
Coordination of benefits Which of the following provisions ensures that an insured patient’s benefits form third party payers do not exceed 100% of allowable medical expenses?
G51.0 A patient presents to a provider’s office with difficulty speaking, facial dropping, and an inability to close their left eye. They are diagnosed with Bell’s palsy. A billing and coding specialist should report which of the following ICD-10-CM codes?
Phone number Which of the following pieces of guarantor information is required when establishing a patient’s financial record?
Report the incident to a supervisor A billing and coding specialist observes a colleague perform an unethical act. Which of the following actions should the specialist take?
Provider 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 agreement?
Excisional procedure A billing and coding specialist is reviewing the procedure notes from a provider who selected a code indicating an incisional biopsy when the entirety of the patient’s lesion was removed. The specialist should verify with the provider that which of the following types of procedures was performed?
Resubmit an updated claim A billing and coding specialist is reviewing a report from the clearinghouse after submitting electronic claims and notices that one claim was rejected due to missing demographic information. Which of the following actions should the specialist take?
-F1 A billing and coding specialist is preparing a claim for a patient who had a procedure performed on their left index finger. Which of the following modifiers indicates the correct digit?
Plus sign Which of the following symbols indicated an add-on code in the CPT manual?
Tertiary care referral A patient who recently received care from an endocrinologist is being referred to an infectious disease specialist. Which of the following types of referrals does the patient need from the endocrinologist?
Coronary artery bypass graft A billing and coding specialist is preparing a claim for a provider. The operative note indicated the surgeon performed a CABG. The specialist should identify that CABG stands for which of the following?
CMS-1500 claim form A billing and coding specialist should identify that which of the following is used to improve the efficiency and effectiveness of the health care system as mandated by HIPAA for providers?
-25 A billing and coding specialist is reviewing a claim for a patient who presented to the providers office for an upper respiratory infection. During the encounter, the patient also received the influenza vaccine. Which of the following modifiers should be attached to the evaluation and management (E/M) code?
Notify Medicare about the overpayment within 60 days A billing and coding specialist is posting a Medicare remittance advice and identifies an overpayment of $15. Which of the following actions should the specialist take?
Medicare part C Which of the following parts of Medicare is managed by private third-party payers that have been approved by Medicare?
Send a copy of the operative report with the claim A billing and coding specialist is preparing a claim for a procedure with a prolonged operative time that has modifier -22 attached. Which of the following actions should the specialist take?
Adjudication Which of the following is the third stage of a claim’s life cycle?
Outstanding balances organized by date A billing and coding specialist is preparing an accounts receivable aging report. The specialist should expect the report to include which of the following?
CMS-1500 claim form Which of the following should a billing and coding specialist complete to be reimbursed for a providers outpatient service?
Payment for the encounter is based on a flat rate A billing and coding specialist is assisting a patient who has a capitated health maintenance organization (HMO) and presents to the office with a sinus infection. The specialist should identify that which of the following statements is true regarding a capitated HMO?
Medically unlikely edits A billing and coding specialist is preparing a claim for an appendectomy and reports it with two units. The claim is then denied. Which of the following coding edits should the specialist have reviewed prior to submitting the claim?
A product pending FDA approval is indicated by a lightening bolt symbol Which of the following information is correct regarding code symbols in the CPT manual?
Health care clearinghouses HIPAA transaction standards apply to which of the following entities?Employers who provide workers compensation plans
Name and address of guarantor Which of the following information is required on a patient account record?
$39 A patient presents to a primary care provider for a closed right index finger fracture. The provider Is non-participating provider for a private payer and does not accept assignments of benefits. The providers charge for the service is $135. The third-party payers usual customary reasonable (UCR) amount is $120 with a 20% coinsurance fee. Which of the following is the patient’s financial responsibility?
Code both the acute and chronic conditions, sequencing the acute condition first When a patient has a condition that is both acute and chronic, how should it be coded?
The parent whose insurance policy has been active the longest will be the primary insurer A billing and coding specialist is determining coordination of benefits for a patient who has health insurance coverage from both parents. The patient’s father’s birthday is May 18, 1982, and their mother’s birthday is May 18, 1984. Which of the following statements is correct for determining coverage?
Patient eligibility is determining at each visit Which of the following is true regarding Medicaid eligibility?
The payer should send reimbursement directly to the provider with the exception of copays and deductibles A billing and coding specialist is filing a CMS-1500 claim form for a patient who has private insurance. The specialist should recognize that a signature approving assignment of benefits indicates which of the following?
Private third-party payers Medigap coverage is offered to Medicare beneficiaries by which of the following?
Verify the age of the account A billing and coding specialist is reviewing a delinquent claim. Which of the following actions should the specialist take first?
$85 A providers office fee is $100, and the Medicare part B allowed amount is $85. Assuming the beneficiary has not met their annual deductible, the patient should be billed for which of the following amounts?
Colostomy A patient has a resection of the intestines with anastomosis through the abdominal walls. Which of the following is a type of anastomosis?
Retrospective review A billing and coding specialist identifies a CPT code that is routinely being denied by a third-party payer. Which of the following types of review should the specialist perform?
To determine which claims are outstanding from third party payers Which of the following is the purpose of running an insurance aging report each month?
99204 A billing and coding specialist is determining the level of service for an office visit for a new patient. Which of the following codes represents a detailed history and detailed exam with moderate medical decision-making?
I10 Which of the following is an example of a diagnostic category code?
Claims are expedited Which of the following is an advantage of electronic claim submission?
Coordination of benefits Which of the following is the provision of health insurance policies that specifies which coverage Is primary and secondary?
Using data encryption software on office workstations Which of the following actions by a billing and coding specialist ensured a patient’s health information is protected?
The claim indicated an incorrect place of service A billing and coding specialist Is reviewing a remittance advice from Medicare and notices that the amount paid for a procedure is less than the contracted amount. Which of the following Is a potential reason for the reduced amount of payment?
State Insurance Commissioner’s office A billing and coding specialist discovers that one private payer has not reimbursed the provider for any claims submitted in the past year. Clean claims have been submitted to the payer and have been acknowledged. Which of the following entities should the specialist contact to report the payer’s failure to submit timely reimbursement?
Accounts receivable Outstanding patient balances will appear on which of the following?
The father is the primary policy holder because his birthday falls first in the calendar year A child is brought into a facility by their mother. The child is covered under both parents’ insurance policies. The child’s father was born on 10/01/1980 and their mother was born on 10/02/1981. Which of the following statements is true regarding the primary policy holder for the child?
-32 An employer’s workers compensation payer requires bloodwork for an employee who experiences a work-related injury. Which of the following modifiers should a billing and coding specialist use?
99213 A billing and coding specialist is reviewing a claim for an established patient who arrived at the office with an upper respiratory infection. Which of the following codes should the specialist use for this encounter?
Apply characters four through seven to a claim Which of the following actions should a billing and coding specialist take to assign a diagnosis code to the highest level of specificity?
“””It’s when a provider requests medical advice from a specialist.””” “A billing and coding specialist is training a new employee on a claim for a consultation. The new employee asks, “”What is a consultation?”” Which of the following responses should the specialist make?”
Call the U.S. Department of Health and Human Services (DHHS) anonymous hotline A billing and coding specialist discovers suspicious billing activity that may be fraudulent in the workplace. Which of the following actions should the specialist take?
Identification A billing and coding specialist is preparing to appeal a partially paid claim due to an incorrect procedure code. Which of the following steps of the appeal process includes the review of the claim adjustment reason code?
Immunizations Z codes are used to identify which of the following?
National Correct Coding Initiative (NCCI) Which of the following editing systems should a billing and coding specialist reference to determine if a supplies and materials code should be assigned to report a surgical tray used during an ambulatory procedure?
Subjective In which of the following sections of a SOAP note does a provider indicate a patient’s reported level of pain?
The guidelines define items that are necessary to accurately code For which of the following reasons should a billing and coding specialist follow the guidelines in the CPT manual?
TRICARE Which of the following is a federal government health insurance program?
Category I modifier A billing and coding specialist is working on a claim in which reimbursement was reduced due to services being bundled. Which of the following types of modifiers should be assigned to indicate multiple procedures were performed to prevent bundling?
Individuals who are under age 65 and have a disability Which of the following qualifies a patient for eligibility under Medicare as the primary third-party payer?
49585 Which of the following CPT codes should a billing and coding specialist use to bill for a 5-year-old child who had a hernia repair?
Both the surgeon and pathologist Based on CPT integumentary coding guidelines, Mohs micrographic surgery involved the provider filling which of the following roles?
Patient information was disclosed to the patient’s parent without consent Which of the following is an example of a violation of an adult patient’s confidentiality?
-58 A patient has a breast biopsy with the placement of a clip. After the biopsy is determined to be malignant, the patient elects for a mastectomy during the global period of the biopsy. Which of the following modifiers should a billing and coding specialist use to report the mastectomy?
Incorrectly linked codes were reported on the claim A billing and coding specialist is reviewing a remittance advice and encounters a denial of payment for CPT code 44950 (appendectomy). The specialist discovers the IDC-10-CM code assigned to the claim was J32.1 (chronic frontal sinusitis). Which of the following is the reason for this claim denial?
The guidelines prior to each section Unlisted codes can be found in which of the following locations in the CPT manual?
Patient account record In an outpatient setting, which of the following forms is used as a financial report of all services provided to patients?
$40 An 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?
-47 A billing and coding specialist is reviewing a patients encounter progress note. Which of the following modifiers indicated the patient received general anesthesia from a surgeon?
Wounds should be grouped by anatomic site and coded in order of complexity A billing and coding specialist is reviewing a provider’s documentation for a patient who underwent repair of multiple wounds to the face and trunk. The provider coded repair of all wounds individually. The specialist should recognize that the provider should have applied which of the following concepts to the documentation of the repair for the patients’ wounds?
Inform the patient of the reason for the denial A patient is upset about a bill they received because their third-party payer denied the claim. Which of the following actions should a billing and coding specialist take?
Internal monitor and auditing Which of the following is part of a provider’s practice compliance program?
Send the medical information pertaining to the dates of service required A providers office receives a subpoena requesting medical documentation from a patient’s medical record. After confirming the correct authorization, which of the following actions should a billing and coding specialist take?
Office or other outpatient services A new patient presents for an urgent care encounter. Which of the following code sets should be used to report this encounter?
The patient accepts the policies and procedures regarding how protected health information (PHI) is handled When a patient signs an Acknowledgement of Notice of Privacy Practice. It indicated which of the following?
To verify that the medical records and the billing record match Which of the following is the purpose of an internal review in a provider’s office?
When the patient contacts the providers office and schedules an appointment When should a billing and coding specialist initiate the collection of the information needed to process a patient’s insurance claim form?
Temporary disability A billing and coding specialist is processing a claim for a patient who broke their arm while repairing cars at their workplace. There is no nerve damage, the arm is placed in a cast for 6 weeks, and the patient is cleared to return to work in 6 weeks. Which of the following types of workers compensation applies to this patient?
Invalid A claim is submitted with a transposed insurance member ID number and returned to the provider. Which of the following describes the status that will be assigned to the claim by the third-party payer?
A bilateral procedure A billing and coding specialist should add modifier -50 to a code when reporting which of the following?
Medical record documentation A billing and coding specialist is preparing an appeal letter in response to a denial by a third-party payer for lack of medical necessity. Which of the following should the specialist include with the letter to indicate medical necessity?
-24 A billing and coding specialist is reviewing a claim that was denied for services provided during the postoperative period. The patient was diagnosed with pneumonia during a postoperative encounter for a knee joint replacement 2 weeks ago. Which of the following modifiers should the specialist add to the claim prior to resubmitting?
$120 A patient has met a Medicare deductible of $150. The patient’s coinsurance is 20%, and the allowed amount is $600. Which of the following is the patients out of pocket expense?
Clearinghouses, health insurance companies, and billing services Which of the following entities are required to follow HIPAA rules and regulations?
Diagnosis pointer Which of the following links the ICD-10-CM and CPT codes for claims processing?
Code signs and symptoms in the absence of a definitive diagnosis Which of the following is a valid ICD-10-CM principle?
Telemedicine The star symbol in the CPT coding manual is used to indicate which of the following?
Notify the patient between 3 and 10 days prior to depositing each check on the indicated date A billing and coding specialist is arranging a payment plan with a patient who wants to leave postdated checks with the office. The patient proposes leaving one check postdated for 3 months, one for 4 months, and another one for 5 months in the future. According to federal collection law, which of the following actions should the specialist take?
The claim requires an attachment to support medical necessity For which of the following reasons should a claim be resubmitted?
Photocopy both sides of the new card When reviewing and established patients’ insurance card, a billing and coding specialist notices a minor change from the existing card on file. Which of the following actions should the specialist take?
Health maintenance organization (HMO) A patient wants to see an endocrinologist for a consultation about their diabetes mellitus, but they must see their primary care provider (PCP) for a referral to an in-network specialist first. Which of the following types of insurance does the patient have?
99213 A billing and coding specialists preparing a claim for an established patient who arrived for an annual exam. During the examination, the provider treated the patient’s sinus infection and prescribed medication for it. Which of the following evaluation and management (E/M) codes requires modifier -25?
Add-on codes Which of the following are qualifying circumstances in the anesthesia section of the CPT manual?
Establish coordination of benefits A billing and coding specialist is determining third party payer responsibilities for a 70-year-old patient who has Medicare coverage, The patient’s spouse has insurance with Blue Cross Blue Shield through their employer. Which of the following actions should the specialist take?
National Coverage Determination (NCD) Which of the following is used by Medicare to determine if an item or service is covered?
Benign vs. malignant status A billing and coding specialist is reviewing an encounter note that indicates a biopsy was performed. The specialist required which of the following additional details to fully code this procedure?
Dates of coverage A billing and coding specialist is collecting demographic information from a patient. Which of the following pieces of information should the specialist expect the Medicaid eligibility verification system (MEVS) to provide?
Suspended A billing and coding specialist is reviewing delinquent claims and discovers that a third-party payer paid a claim but applied it to the incorrect provider. The third-party payer will reimburse the payment once the improperly paid funds are recouped. Which of the following terms is used to describe this claim?
Biological mother A billing and coding specialist is submitting a claim for a school-age child who was brought to the clinic by their maternal grandmother. The child’s parents are divorced and remarried, and the child’s mother has legal custody of the child. The specialist should recognize that the child’s primary insurance coverage is provided through which of the following insured individuals?
Contact the patient for assistance A billing and coding specialist receives a denial for payment from TRICARE for services provided in the emergency department while a provider was on call. The provider is not a participating TRICARE provider. Which of the following actions must the specialist take to process an appeal for payment?