NHA Certified Billing and Coding Specialist (CBCS) Practice Exam

These questions are part of the practice quiz. Start practicing

• This describes the procedures and best practices for correct coding?
• All of the following are correct regarding add-on codes except:
• Which scenario would most likely result in a denial on a Medicare claim?
• Which term specifically matches the concept of the patient's responsibility for part of the charge after insurance applies?
• Which of the following best describes the information shown in the remittance advice regarding patient charges?
• Block 17b on the CMS-1500 form is used for which purpose?
• What is the third stage of the life cycle of a claim?
• Which party bears responsibility for the difference between billed amount and allowed amount on remittance advice?
• Which procedure uses an arthroscope to view inside a joint?
• What is the primary function of the respiratory system?
• The portion of a medical bill paid by the patient as part of insurance is:
• If a Medicare claim is submitted electronically and there are no errors, what is the classification?
• Which of the following actions by a billing and coding specialist would be considered fraud?
• Which statement correctly describes precertification and preauthorization in Medicare billing?
• Which statement is true regarding release of patient records in relation to psychotherapy notes?
• A Medicare/Medicaid crossover claim submitted by a participating provider has what patient responsibility?
• In a scenario involving on-the-job exposure, which payer is typically responsible for ED charges?
• When a third-party payer requests copies of patient information related to a claim, which document must be included in the patient’s file?
• A physician orders a comprehensive metabolic panel for a 70-year-old patient with Medicare as primary. Which form is used to inform the patient that she may be responsible for payment?
• If the assignment of benefits box on a CMS-1500 is checked "yes," who receives payment?
• Block 33a on the CMS-1500 claim form should contain which information?
• Which standardized formats are used in the electronic filing of claims?
• The symbol 'O' in CPT indicates which of the following?
• Which statement best describes the purpose of remittance advice in claims processing?
• What information is required on a patient account record?
• Which measure helps protect the privacy of health information on office computers?
• What is a pre-existing condition?
• Which form does a third-party payer require for physician services?
• One purpose of an internal auditing program in a physician's office is to verify what?
• On the CMS-1500 form, if more than 12 diagnoses must be reported, what must be done?
• This describes an obstruction of the urethra?
• Which NPI is required in Block 33a of a CMS-1500 claim form?
• Which CPT symbol indicates a product pending FDA approval?
• Which of the following is a reason a claim would be denied?
• Which quadrant describes the location of the small and large intestines, the appendix, and the right ureter?
• A patient with a primary malignant neoplasm of the lung should be referred to which specialist?
• Which law prohibits a provider from referring Medicare patients to a clinical laboratory service in which the provider has a financial interest?
• Which form should the billing and coding specialist transmit to the insurance carrier for reimbursement of inpatient hospital services?
• On a claim form, where is the rendering provider's NPI located?
• Which statement about psychotherapy notes access is true?
• In a claim where Medicare pays after the primary insurer has paid, this Medicare payment collection is called:
• Which entity is commonly associated with defining essential elements of a comprehensive compliance program?
• The physician bills $500 to a patient; the claim is denied by insurance, and the patient still owes $500 for the year. This amount is called what?
• If block 13 is left blank when submitting a claim, what is the expected outcome?
• In the BCBS example, what is the amount the payer pays after deductible on the remaining balance?
• Precertification is used for which purpose?
• Which organization introduced Medicare documentation guidelines in 1995 and 1997 to ensure services billed were medically necessary?
• Category III CPT codes are designed for what kind of coding?
• ICD-10-CM stands for which of the following?
• In a scenario where assignment of benefits is not accepted, who is typically billed directly?
• Which entity is used to electronically submit medical claims to payers?
• Which of the following is an example of a remark code from an explanation of benefits document?
• The aging of accounts receivable primarily helps identify what?
• Which describes a two-digit CPT code used to indicate that the provider supervised and interpreted a radiology procedure?
• In billing terms, what term describes the amount the policyholder owes the provider after all other payments are applied?
• Which of the following is true about coding acute and chronic conditions?
• A claim that is 120 days old would be classified as which status?
• Which report is used to identify outstanding accounts based on how long they have been due?
• Which term describes the amount that is adjusted after processing a claim to reflect payer edits or contractual adjustments?
• 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?
• For a married patient where both spouses have group insurance, which policy is typically primary for the patient’s appointment?
• Block 33a on the CMS-1500 claim form should contain the provider's identifier known as what?
• Which coding manual is used primarily to identify products, supplies, and services?
• Which CMS initiative is designed to detect inappropriate coding and ensure proper code use?
• Which describes the organization of an aging report?
• Which term would be used to describe Medicare recovery after the primary payer has processed the claim?
• Which modifier is used to report multiple procedures?
• What coding system, abbreviated ICD, is used to classify diseases and health problems?
• The organization that initiated ICD codes is which of the following?
• Which of the following would result in a claim being denied?
• In radiology coding, what term describes the portion of the service that reflects the radiologist's interpretation?
• Code that covers physicians' services and hospital outpatient coding
• Which term best describes the process of handling multiple insurers so that patient benefits do not exceed allowable expenses?
• Which describes the term 'crossover' as it relates to Medicare?
• Block 32 on CMS-1500 is used to capture which type of information?
• A coding specialist should use which modifier to report multiple procedures?
• The portion of healthcare costs that the patient is responsible for paying is known as:
• Which charge should be sent to collections first among four past-due charges: $400 (10 weeks past due), $800 (6 weeks past due), $1,000 (4 weeks past due), and $2,000 (8 weeks past due)?
• NPI for referring provider is located in which CMS-1500 block?
• If a physician accepts the allowed amount and the insurer allows 80 of 120, with $50 of deductible not yet met, how much should be written off?
• What action should be taken if an insurance company denies a service as not medically necessary?
• For TRICARE, what identification is required for dependents 10 years of age or older?
• How often is Medicaid patient eligibility determined?
• A patient diagnosed with primary lung cancer would be managed by which specialist?
• In the BCBS example, after applying the deductible to the balance, what is the remaining balance that could be paid by the insurer?
• A patient is upset about a bill after the insurer denied the claim. What is the most appropriate action for the provider to take?
• Which provision ensures that insureds' benefits from all insurers do not exceed 100 percent of allowable medical expenses?
• What is considered the final determination of the issues involving settlement of an insurance claim?
• Which of the following documentation is a valid authorization to release medical information to the judicial system?
• When determining patient financial responsibility by reviewing the remittance advice, which statement is true?
• Which stage involves the payer deciding if a claim is payable and for what amount?
• Which of the following is true about the professional component 26 modifier?
• In an HMO, which service typically requires a referral from the primary care physician?
• On the CMS-1500 claim form, which block is used to accept assignment of benefits?
• Which quadrant describes the location of the stomach, spleen, part of the pancreas, part of the liver, and portions of the small and large intestines?
• All e-mail correspondence containing patient's PHI sent to a third-party payer should be?
• Which is an example of Medicare abuse?
• Which condition indicates a claim should be submitted on paper rather than electronically?
• Accepting assignment on a CMS-1500 claim form indicates which of the following?
• In burn coding, which percentage is used for a front torso burn?
• The unlisted codes can be found in which location in the CPT manual?
• If a patient’s employer has not submitted a premium, what claim status should the payer issue?
• For non-crossover claims, the billing & coding specialist should prepare an additional claim for the secondary payer and send it with a copy of which document?
• ERA stands for which of the following?
• When you notice a minor change on a patient's insurance card on file, what is the recommended action?
• Code designed to serve as supplemental tracking codes that can be used for performance measurement
• For which situation is precertification especially important?
• Which document itemizes charges, date of service, CPT codes, ICD-10-CM, fees, and copayment information?
• An EOB shows billed $80, allowed $60, and a $20 copayment. Which amount should be posted as the insurance check amount?
• Category I CPT codes cover which area?
• When submitting a clean claim with a diagnosis of kidney stones, the name of the procedure is?
• What is the Medicare claim submission deadline?
• Why is accurate completion of encounter forms important for claim processing?
• Which block requires the patient's authorization to release medical information to process a claim?
• With four past-due payments, which balance should be sent to collections first?
• What does RAC stand for in CMS claim reviews?
• When a claim billed for a level four office visit is paid at a level three, what should you do?
• What is the correct statement about the limiting charge in the non-participating scenario?
• What does two triangular symbols (⧓) represent?
• Which of the following best defines a pre-existing condition?
• Which notes are explicitly exempt from the HIPAA Privacy Rule protections?
• Which format is used to submit claims electronically to a third party payer?
• Which document is used to submit supporting materials with a claim?
• The Medicare term for money recovered by Medicare after the primary insurer pays is:
• What is the name of the financial record generated by a provider's office that tracks charges and payments?
• Which of the following is a federal government health insurance program?
• A Medicare non-participating (non-PAR) provider's approved payment amount is $200 for a lobectomy and the deductible has been met. Which of the following amounts is the limiting charge for this procedure?
• Which statement is accurate regarding the diagnostic codes in Block 21 on a CMS-1500 claim form?
• For a patient whose Medicare is the primary payer, which notice is used to inform about potential out-of-pocket costs for non-covered services?
• Which term describes the two-digit CPT code used to indicate that the provider supervised or interpreted a radiology procedure?
• Which symbol indicates a new code?
• The Advance Beneficiary Notice (ABN) serves to inform patients about potential non-coverage and their financial responsibility.
• Threading a catheter with a balloon into a coronary artery and expanding it to repair arteries describes which procedure?
• A provider receives reimbursement from a third-party payer accompanied by which document?
• When a patient has a condition that is both acute and chronic, how should it be reported?
• A billing and coding specialist submitted a claim to Medicare electronically. No errors were found by the billing software or clearinghouse. Which describes this claim?
• Block 27 on the CMS-1500 claim form is used to indicate which of the following?
• What symbol denotes telemedicine in CPT coding?
• Which of the following is a key component of an evaluation and management service?
• Code used for temporary coding for new technology and services that have not met the requirements needed to be added to the main section of the CPT book
• Which of the following statements describes electronic claim submission correctly?
• To ensure appropriate insurance coverage for an outpatient procedure, which process should be used first?
• Which term describes a verbal or written agreement that permits the release of patient information?
• In CPT coding, which symbol indicates a product pending FDA approval?
• Pleurocentesis is used to obtain fluid from which body cavity?
• A patient account record should include which guarantor information?
• Which entity defines the essential elements of a comprehensive compliance program?
• Which structure carries urine from the kidneys to the bladder?
• On the CMS-1500 form, which field indicates the diagnosis code?
• A patient with an HMO insurance plan needs to see a specialist. From which person should the patient obtain a referral?
• Which symbol indicates an add-on code?
• A non-participating (non-PAR) provider who does not accept assignment can collect a maximum of what percentage (the limiting charge) over the non-PAR Medicare fee schedule amount?
• Which modifier should be used to indicate a discontinued outpatient procedure after anesthesia administration?
• What is the policy called that outlines procedures for proper coding and compliance within a medical practice?
• Which symbol denotes an out of numerical sequence code?
• The billing and coding specialist should follow the guidelines in the CPT manual for which purpose?
• Which modifier indicates a reduced service?
• Which quadrant describes the location of the right lobe of the liver, the gallbladder, part of the pancreas, and part of the small and large intestine?
• Which modifier should be used to indicate that a service code was reduced from its original description?
• Which quadrant contains the gallbladder?
• What document does a patient sign to authorize payment of claims directly to the provider?
• Which professional is typically responsible for issuing referrals for an HMO patient?
• A patient is diagnosed with metastatic bone neoplasm. The neoplasms will be coded as?
• An organization that initiated the development of ICD codes is?
• Which of the following represents a best-practice action for billing patterns?
• Which item is required when establishing a patient's financial record as guarantor information?
• Which statement accurately describes how crossover works in Medicare billing?
• What color is acceptable on the CMS-1500 claim form?
• If a patient's employer has not submitted a premium payment, which claim status should the provider receive from the payer?
• Which action by the billing and coding specialist prevents fraud?
• On a CMS-1500 claim form, which information belongs in Block 32?
• Which part of the medical record is most relevant to determining the Evaluation and Management code used for billing?
• In a BCBS EOB example, charged 100, allowed 80, deductible 40 applied, payer pays 80% of the balance. How much should the patient pay?
• Which statement about Medicaid eligibility is true?
• A 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 with coverage of care, which of the following should occur?
• Which of the following is considered fraud?
• What term refers to the difference between billed charges and the allowed amount?
• Which term describes standardized formats used for electronic claim submission?
• On the CMS-1500 claim form, which block is used to enter secondary insurance information such as AARP?
• Which coding system is used to code diseases, injuries, impairments, and other health-related problems?
• When submitting a Medicaid claim for a patient who has primary and secondary insurance, which item should be attached with the Medicaid claim?
• What is the maximum number of modifiers that can be reported on a CMS-1500 claim form in Block 24D?
• In which block on the CMS-1500 claim form should the referring provider’s national provider identifier (NPI) be entered?
• Which statement best defines claim adjudication?
• Which of the following causes a claim to be suspended?
• What term describes the amount the payer approves to pay for a service?
• When reviewing a delinquent claim, what action should be taken first?
• What is a requirement of some third party payers before a procedure is performed?
• If two parents both cover a dependent child, which parent is considered the primary insurance holder?
• CPT codes on a claim form are used to report what?
• Which action would constitute a HIPAA violation in the given scenario?
• Which report is used to organize accounts receivable from the date of service?
• Which term describes an insurance carrier that pays the provider who rendered services to a patient?
• Which term is used to communicate why a claim line item was denied or paid differently than billed?
• After a third-party payer validates a claim, what occurs next?
• If a payer denies a service as not medically necessary, what is the recommended recourse?
• Which organization identifies improper payments made on CMS claims?
• Temporary HCPCS codes are used to report which items?
• The CMS-1500 form is primarily used to bill which type of services?
• Given an explanation of benefits showing billed amount $80, allowed amount $60, and patient copayment $20, which amount should be posted as the insurance payment?
• Which document explains why Medicare may deny a service and outlines potential patient financial responsibility?
• ICD-10-CM codes on a claim are used to report which information?
• The balance the policyholder must pay the provider is called what?
• The term used when Medicare seeks repayment after the primary payer has settled a claim describes:
• Which items are examples of patient cost-sharing in the given example?
• A coding specialist should use which modifier to report reduced services?
• A patient presents chest pain; the provider talks to a cardiologist prior to obtaining consent due to HIPAA provisions. Which portion of HIPAA is cited?
• Which of the following options is considered proper supportive documentation for reporting CPT and ICD codes for surgical procedures?
• What shows outstanding balances?
• Which item should a billing and coding specialist use to submit a claim with supporting documents?
• What is the term for the sac that encloses the heart?
• Cryosurgery uses which type of treatment?
• Which term refers to the final decision in resolving an insurance claim?
• Which term best describes medical ethics?
• Which Medicare term describes payment recovered after the primary insurer pays?
• Which symbol indicates a revised code?
• Which practice helps protect PHI by securing data on office workstations?
• Which CMS-1500 block indicates an ICD diagnosis code?
• What is the purpose of the CMS documentation guidelines introduced in the 1990s?
• The authorization number for a service that was approved before the service was rendered is indicated in which CMS-1500 block?
• A coroner's autopsy includes which examination?
• Which privacy measure ensures protected health information (PHI)?
• Which department is typically responsible for psoriasis treatment?
• Which term describes the payment the patient makes at the time of service to cover part of the cost?
• Which of the following is included in the release of patient information?
• Medical ethics are?
• Which electronic form is used to post payments?
• Which term describes the process of coordinating payments across multiple insurers?
• Which modifier should be used to indicate a professional service has been discontinued prior to completion?
• What does NCD stand for in Medicare terminology?
• A triangle (🞁) represents?
• Which symbol marks a change in the code description since the last edition?
• Which organization fights waste, fraud, and abuse in Medicare and Medicaid programs?
• In TRICARE, what type of identification is documented for dependents aged ten and older?
• The patient’s share of costs after insurance is applied is called:
• A new patient is defined as which of the following?
• If a deductible is unmet and a copayment applies, how is the patient’s total financial responsibility determined?
• A patient with a past due balance requests that their records be sent to another provider. What action should the office take?
• A subpoena for medical documentation is received and authorization is confirmed. What action should the billing and coding specialist take?
• In a billing system, where is the charge that exceeds the payer's allowed amount typically recorded?
• When the remittance advice is sent from the third-party payer to the provider, which action should the billing and coding specialist perform first?
• Which initiative did CMS implement in 1996 to detect inappropriate and improper codes?
• Which document would you consult to determine the exact steps performed during a surgical procedure for coding?
• Ambulatory surgery center, home health care, and hospice organizations use which claim form?
• To determine the number of outstanding claims, which routine analysis should a billing and coding specialist perform?
• Medigap coverage is offered to Medicare beneficiaries by which type of payer?
• A prospective billing account audit prevents fraud by reviewing and comparing a completed claim form with which document?
• Category II CPT codes are used to track what?
• Which sections of the medical record are used to determine the correct Evaluation and Management code for billing?
• What is the purpose of precertification?
• Which of the following qualifies as an exception to the HIPAA Privacy Rule?
• A physician's office fee is $100 and the Medicare Part B allowed amount is $85. If the beneficiary has not met their annual deductible, how much should be billed to the patient?
• When correcting an error in a medical record, what information must accompany the correction?
• Which provision ensures that the combined benefits from multiple insurers do not exceed 100% of allowable expenses?
• The patient’s health plan is referred to as the 'payer of last resort.' The patient is covered by which plan?
• Which statement best describes HCPCS Level 2?
• Which symbol is used to denote a new code in the edition update?
• Which of the following options is a HIPAA compliance guideline affecting electronic health records?
• What is the medical term for puncturing the space between the ribs to withdraw fluid from the chest cavity?
• Which is allowed when billing procedural codes?
• What are the three key components of an E/M code?
• If a patient pays out-of-pocket for services after insurance coverage, this is referred to as:
• Which symbol indicates a moderate sedation?
• A claim is denied due to termination of coverage. Which action should the billing and coding specialist take next?
• In the BCBS scenario, what is the total amount the patient is responsible for paying?
• In the EOB scenario, billed amount is $170, allowed amount is $150, the deductible is $50, and the copayment is $20. What is the patient’s responsibility?
• In the context of coordination of benefits for a married patient with two employer-based plans, which plan is typically billed first for the patient’s care?
• If a patient comes in for an office visit and had an EM, what is the first diagnosis?
• Which term describes when a plan pays 70% of the allowed amount and the patient pays 30%?
• In legal proceedings involving medical records, which document orders the production of records?
• A provider charged $500 to a claim with an allowable amount of $400. In which column should the non-allowed charge be posted?
• Which phrase best describes the need for a supplementary item with a paper claim?
• The way to correct an error on a patient's medical record is?
• When coding on the UB-04 form, the first listed diagnosis code is described as which?
• The CPT guidelines specify what is necessary to do what, with respect to coding accuracy?
• Which block on the CMS-1500 claim form is used for procedures, services, or supplies?
• Identify the Medicare term for a payment that is collected after the primary payer's payment.
• The left lower quadrant contains which structures?
• Which is an example of electronic claim submission?
• Which modifier indicates a discontinued outpatient procedure prior to anesthesia administration?
• On the CMS-1500 claim form, blocks 14 through 33 contain information about which of the following?
• What codes are used to explain why a claim line item was paid differently than billed?
• When coding a front torso burn, which percentage is coded?
• Which Medicare policy determines if a particular item or service is covered by Medicare?
• What is the main purpose of precertification in outpatient billing?
• To determine how much Medicare paid on a claim before billing secondary insurance, which document should be consulted?
• Which plane divides the body into left and right?
• If you witness unethical conduct by a colleague, what action is appropriate?
• Z codes are used to identify
• A physician's office fee is $100 and the Medicare Part B allowed is $85. Assuming the beneficiary has not met his annual deductible, the office should bill the patient for which of the following amounts?
• What does a bullet (∙) represent?
• In the anesthesia section of the CPT manual, which of the following are considered qualifying circumstances?
• Which quadrant describes the location of the small and large intestines and the left ureter?
• A coding specialist should use which modifier to report a bilateral procedure?
• Which document informs a patient that they may be responsible for payment before Medicare covers or denies a service?
• Which part of the Medicare insurance program is managed by private, third-party insurance providers approved by Medicare?
• What is the primary function of the heart?
• Which term best describes the professional standard guiding ethical medical practice?
• Which modifier should be used to indicate a discontinued outpatient procedure prior to anesthesia administration?
• If a level four office visit is paid as level three, which action should be taken?
• Which quadrant includes the appendix and the right ureter?
• Which anatomical structures transport urine from the kidneys to the bladder?
• Which section of the SOAP note indicates a patient's level of pain to a provider?
• What does modifier 26 indicate when billing radiology services?
• What is the percent of payment held back for a risk account in the HMO program called?
• Which causes a claim to be suspended?
• Which code represents the electronic claim submission format used in healthcare payer networks?
• The >< symbol is used to indicate new and revised text other than which of the following?
• If a clean claim is received on March 1, what is the latest allowable payment date to meet Medicare compliance requirements?
• Temporary codes for drugs and medical equipment are what type of HCPCS codes?
• The portion of the charge that a patient pays at the time of service is called what?
• The policyholder's portion of the bill, not covered by the insurer, is called:
• Blocks 14 through 33 on the CMS-1500 claim form primarily report which information?
• Which of the following conditions is most likely to cause a denial under Medicare guidelines for cancer treatment?
• Which organization fights waste, fraud, and abuse in Medicare and Medicaid?
• Block 17b on the CMS-1500 form contains which information?
• Which symbol marks a change in text or definition between triangles?
• Which type of claim is submitted and then optically scanned by the insurance carrier into an electronic form?
• Which form should the billing and coding specialist transmit to the insurance carrier for reimbursement of inpatient hospital services?
• Which symbol indicates exemptions to modifier 51?
• If a service is not covered by the insurer and there are no errors on the claim, what is the next step?
• On a remittance advice form, who is responsible for writing off the difference between the amount billed and the amount allowed by the agreement?
• What term describes a service that was approved by the payer before it was performed?
• Which component of an Explanation of Benefits expedites a phone appeal?
• Under release of patient information, which item is included?
• What is the purpose of coordination of benefits?
• On the CMS-1500 claim form, block 32 should contain which information?
• Given billed $170, allowed $150, deductible unmet $50, copayment $20, what is the patient’s responsibility?
• What is the advantage of electronic claim submission?
• Which term describes the procedure of examining a knee joint using small incisions and an endoscope?
• In medical billing, DOS is an acronym for what?
• Which quadrant contains the left ureter?
• On the CMS-1500 claim form, blocks 1 through 13 include?
• A billing and coding specialist can ensure appropriate insurance coverage for an outpatient procedure by first using which process?
• What is the standard electronic claim submission format used to submit claims to third-party payers?
• Which of the following terms defines the portion of costs the insured must cover?
• The patient's birth date on the CMS-1500 claim form is entered in what format?
• The aging report is used to track which of the following?
• For non-crossover claims, the additional claim for the secondary payer should be sent with a copy of which document?
• A billing and coding specialist preparing a claim form for a provider from a group practice should enter the rendering provider's national provider identifier (NPI) into which of the following blocks on the CMS-1500 claim form?
• Where would you typically find guidelines for unlisted CPT codes?
• Block 33a requires which identifier?
• In CPT coding, which statement accurately describes code symbols?
• A patient has laboratory work done in the emergency department after an inhalation of toxic fumes from a faulty exhaust fan at her place of employment. Which of the following is responsible for that charges?
• Which statement describes a clean claim's characteristics?