NHA CBCS EXAM 2023-2024 ACTUAL EXAM 200 QUESTIONS
AND CORRECT ANSWERS (DETAILED AND VERIFIED
ANSWERS) |ALREADY GRADED A+
A patient has a diagnosis of chest pain. The billing and coding specialist should link the diagnosis to the procedure in which of the following blocks on the CMS- 1500 form - ANSWER- 24D
A provider's office is being investigated for fraud. Which of the following processes will be reviewed first - ANSWER- Compliance Plan
Which of the following entities works with Centers for Medicare and Medicaid services to prevent over payment - ANSWER- Medicaid Integrity contractors
Which of the following actions by a billing and coding specialist is insurance abuse - ANSWER- Using a health insurance identification number other than the patients to ensure payments
Which of the following refers to payers electronically transferring date in order to facilitate coordination of benefits on a clean claim - ANSWER- Crossover
Which of the following is responsible for the health care of its policyhold- ers and identifies health insurance, facilities, providers, or health systems? - ANSWER- Managed care Organization
A patient who has TRICARE is seen in the office for a diagnostic test.The test is $500, and the allowable amount is $250. The patient has a 20% cost share, a deductible of $1000, and a catastrophic cap benefit that have all been met. How much should the billing specialist adjust on this visit -
ANSWER- $200
Which of the following is the amount that the patient is financially respon- sible for before the insurance policy provides coverage - ANSWER- Deductible
The balances listed on an insurance aging report represent which of the following - ANSWER- Outstanding amounts owed to the practice 1 / 4
To ensure all claims are being submitted and received, a billing and coding specialist should document all claims processing on which of the following - ANSWER- An aging insurance report
Which of the following terms describes a procedure that visualizes the inside of a knee - ANSWER- Arthrography
The field " Insured's ID Number" located on the CMS-1500 claim form is used to report which of the following pieces of information - ANSWER- Policy Number
A certified billing and coding specialist should always check to see that the patient registration form includes which of the following - ANSWER- Social security number
A billing and coding specialist who bills for services that are not undertaken at the current appointment is performing which of the following - ANSWER- Fraud
What is a claim called when the billing and coding specialist checks off both Medicare and Medicaid in Block 1 on the CMS-1500 claim form - ANSWER- Cross over claim
A patient is informed that they are required to pay a predetermined fee at the time of service. This fee is known as which of the following terms - ANSWER- CoPay
When identical procedures or services are preformed on the same day, which of the following should the billing and coding specialist update on the CMS-1500 form - ANSWER- Modifier -59
Which of the following terms describes the transmission of data for processing by payer or clearing house - ANSWER- Claims Submission
Which of the following reports is an analysis of accounts receivable indicating 60,90, and 120 days past due - ANSWER- Account aging report
A patient has changed policies and her coverage is now with her 2 / 4
partner. Which of the following information from the partner is required t bill the patient's claims - ANSWER- Policy number
Which of the following should be placed in a patient's financial file - ANSWER- nsurance identification
Which of the following diagnoses can be found in the neoplasm table - ANSWER- Basal cell carcinoma
A patient has a $300 deductible and a 20% coinsurance. The charge amount and allowed amount are both $2,000, and the health plan has paid 80%. Which of the following is the patients responsibility - ANSWER- $340
A Medicare patient with a Medigap policy is charged $100 for an office visit. The approved amount is $60 and the patient has met their deductible.How much should the billing and coding specialist post as a write off - ANSWER- $40
Which of the following describes the process of calculating a patient's liability for a procedure - ANSWER- Predetermination
After a billing a coding specialist submits a claim, what is Medicare's time limit for the submission - ANSWER- 90 days from the date of service
Which of the following terms describes the process of identifying the maximum dollar amount that an insurance carrier will pay for a procedure? - ANSWER- Pre- approval
Which of the following government agencies has launched a website to help consumers identity sources of public and private coverage - ANSWER- DHHS
A sinus procedure with a health maintenance organization (HMO) requires which of the following - ANSWER- Preauthorization
A billing and coding specialist has received a remittance advice in which the allowed amount was 70$ on a charge amount of $110 and the patient has a coinsurance of 10%. Which of the following amounts should the specialist use as an adjustment - ANSWER- $35
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A provider accepts pre-established payments for providing services to enrollees for 1 year. Which of the following plans does this describe - ANSWER- PPO
A patient's progress notes indicates that she is primigravida. Which of the following describes the patient's condition - ANSWER- Pregnant for the first time
A paper claim is registered due to missing information. Which of the following actions should the billing and coding specialist take once the claim is corrected - ANSWER- Resubmit the corrected claim
After identifying a code in the alphabetic index, a billing and coding specialist should verify the code using which of the following resources - ANSWER- Tabular List
To verify TRICARE eligibility, the provider electronically accesses which of the following - ANSWER- Defense Enrollment Eligibility Reporting system
At what point in the billing process is an explanation of benefits (EOB) sent to the patient - ANSWER- After the claim gets paid or denied
A patient has primary and secondary insurance. If a patient receives ser- vices totaling $100, which of the following prevents both insurance payers from paying $100 for the service - ANSWER- Coordination of benefits
Which of the following types of insurance coverage requires a signed Advanced Beneficiary Notice of Noncoverage (ABN) form is payment is expected to be denied - ANSWER- Medicare
A new patient who has a preferred provider organization (PPO) presents to the office reporting stomach pains. For which of the following reasons does the patient have to pay out of pocket for this office visit - ANSWER- he patient has not met the deductible
Which of the following is a state-mandated third-party payer - ANSWER- Medicare
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