NHA CBCS EXAM REVIEW QUESTIONS &
ANSWERS LATEST REVISED 2023/2024
Which of the following Medicare policies determines if a particular item or service is covered by
Medicare? - 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? - A billing and coding specialist should routinely analyze which of the following to determine the
number of outstanding claims? - Ans-Aging report
Which of the following should a billing and coding specialist use to submit a claim with supporting
documents? - Ans-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? - Ans-Claim adjustment codes
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? - Ans-Send the medical information pertaining to the dates of service
requested
On a CMS-1500 claim form, which of the following information should the billing and coding
specialist enter into Block 32? - Ans-Service facility location information
Which of the following is the deadline for Medicare claim submission? - Ans-12 months from the
date of service
Which of the following forms does a third-party payer require for physician services? - Ans-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? - Ans-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? - Ans-Adjustment
Which of the following HMO managed care services requires a referral? - Ans-Durable medical
equipment
Which of the following explains why Medicare will deny a particular service or procedure? - Ans- Advance Beneficiary Notice (ABN)
Which of the following types of claims is 120 days old? - Ans-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? - Ans-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? - Ans-The wife's insurance
Which of the following would most likely result in a denial on a Medicare claim? - Ans-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? - Ans-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? - Ans-Pleurocentesis
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