NHA - Certified Billing and Coding Specialist (CBCS) Study Guide Latest Update 2024-2025 Actual Exam with 150 Questions and 100% Verified Correct Answers Guaranteed A+ Approved by the Professor
A billing and coding specialist can ensure appropriate insurance coverage for an
outpatient procedure by obtaining what? - CORRECT ANSWER: Precertification
A claim can be denied or rejected for which of the following reasons? - CORRECT
ANSWER: Block 24D contains the diagnosis code
A coroner's autopsy is comprised of what examinations? - CORRECT ANSWER: Gross
Examination
A patient's health plan is referred to as the "payer of last resort." What is the name of
that health plan? - CORRECT ANSWER: Medicaid
Abstracting - CORRECT ANSWER: The extraction of specific data from a medical
record, often for use in an external database, such as a cancer registry.
Abuse - CORRECT ANSWER: Practices that directly or indirectly result in unnecessary costs to the Medicare program.
Account Number - CORRECT ANSWER: Number that identifies specific episode of
care, date of service, or patient.
Accounts Receivable Department - CORRECT ANSWER: Department that keeps track
of what third-party payers the provider is waiting to hear from and what patients are due to make a payment.
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Advance Beneficiary Notice of Noncoverage - CORRECT ANSWER: Form provided if a
provider believes that a service may be declined because Medicare might consider it unnecessary.
Aging Report - CORRECT ANSWER: Measures the outstanding balances in each
account.
Allowable Charge - CORRECT ANSWER: The amount an insurer will accept as full
payment, minus applicable cost sharing.
Ambulatory surgery centers, home health care, and hospice organizations use which
form to submit claims? - CORRECT ANSWER: UB-04 Claim Form
APC Grouper - CORRECT ANSWER: Helps coders determine the appropriate
ambulatory payment classification (APC) for an outpatient encounter.
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? - CORRECT ANSWER: 12
Assignment of Benefits - CORRECT ANSWER: Contract in which the provider directly bills the payer and accepts the allowable charge.
At what percentage should a front torso burn be coded? - CORRECT ANSWER: 18%
Auditing - CORRECT ANSWER: Review of claims for accuracy and completeness.
Authorizations - CORRECT ANSWER: Permission granted by the patient or the
patient's representative to release information for reasons other than treatment, payment, or health care operations.
Balance Billing - CORRECT ANSWER: Billing patients for charges in excess of the
Medicare fee schedule.
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