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NHA CBCS FINAL EXAM
QUESTIONS WITH 100% VERIFIED CORRECT ANSWERS
“E Codes - CORRECT ANSWER For durable medical equipment for use in home"
"Add on Codes - CORRECT ANSWER Used for procedures that are always performed during
the same operative session, as another surgery in addition to the primary service/procedure and is never performed separately."
"Medical Ethics are - CORRECT ANSWER Standards of conduct based on moral principals.
Acting within ethical behavior boundries means carrying out one's responsibilities with integrity, decency, respect, honesty, competence, fairness and trust."
"Three Components for E*M Codes - CORRECT ANSWER 1.History
2.Physical Exam 3.Medical Decision-Making"
"Guidelines are Found? - CORRECT ANSWER At the beginning of each section and used to
provide specific coding rules for that section."
"Co-payment - CORRECT ANSWER A fixed fee collected at the time of the patients visit."
"Review Linkage Protocol - CORRECT ANSWER Appropriateness of Codes, Payers rules about
linkage, Documentation to support codes, Compliance with regulation and guidelines"
"Level 2 codes - CORRECT ANSWER National codes for physician and non-physician service not
found in the CPT Level 1"
"Inpatient - CORRECT ANSWER A/An ___________ is a person admitted to a hospital or long-
term care facility(LTCF) for treatment with the expectation that the patient will remain in the hospital for a period of 24 hours or more."
"HIPAA is an acronym for - CORRECT ANSWER Health Insurance Portability and Accountability
Act of 1996."
"Life Cycle of a Claim - CORRECT ANSWER Submission, Processing, Adjudication, Non-covered,
Unauthorized, Medical Necessity Checks, Payment / RA / ERA"
"Level 1 codes - CORRECT ANSWER Codes found in the CPT manual"
"Deductible - CORRECT ANSWER The out-of-pocket payment amount that a policyholder
must meet before insurance covers the service(s) is called?"
"Coinsurance - CORRECT ANSWER A fixed percentage of covered charges applied to the
patients bill after the deductible has been met."
"Liability Insurance - CORRECT ANSWER Covers injuries caused by insured that occurred on
the insured's property."
"Unspecified - CORRECT ANSWER "No notation of benign or malignant status is found in the
diagnosis or in the patient's chart.""
"subpoena - CORRECT ANSWER A writ requiring the appearance of a person at a trial or other
proceeding is a ___________."
"Medicare - CORRECT ANSWER What is the single largest healthcare program in the United
States?"
"Rejected Claim - CORRECT ANSWER A rejected claim is an electronically submitted claim that
is unprocessable due to missing or invalid information required by the payer."
"77010 - 79999 - CORRECT ANSWER Radiology"
"Medicaid Medically Needy - CORRECT ANSWER provide Medicaid to certain groups not
otherwise eligible for Medicaid.must cover: •Pregnant women: •Children under 18: •States have option to cover: •Children up to 21: •Parents and other caretaker relatives: •Elderly: •Individuals with disabilities:"
"CMS - CORRECT ANSWER Centers for Medicare & Medicaid Services"
"MAC - CORRECT ANSWER Medicare Administration Contractor"
"TIN - CORRECT ANSWER Tax Identification Number"
"EFT - CORRECT ANSWER Electronic Funds Transfer"
"ACA - CORRECT ANSWER Affordable care Act"
"NHA - CORRECT ANSWER National Healthcare Association-Started 1989"
"PQRS - CORRECT ANSWER Physician Quality Reporting System"
"EDI - CORRECT ANSWER Electronic Data Interchange"
"EP - CORRECT ANSWER Eligible Provider"
"ERA - CORRECT ANSWER Electronic Remittance advicer"
"NPI - CORRECT ANSWER National Provider Identification"
"EMR - CORRECT ANSWER Electronic Medical Record"
"EOB - CORRECT ANSWER Explanation of Benefits"
"EHR - CORRECT ANSWER Electronic Health Record"
"FFS - CORRECT ANSWER Fee for Service"
"ARRA - CORRECT ANSWER American Recovery Reinvestment Act of 2009"
"MPFS - CORRECT ANSWER Medicare Physician Fee Schedule"
"CAQH - CORRECT ANSWER Coucnil of Affordable Quality healthcare"
"HIPAA - CORRECT ANSWER Health Insurance Portability Accountability Act of 1996"
"CMS - CORRECT ANSWER Center Medicare/Medicaid Service"
"PHI - CORRECT ANSWER Protected Health Information"
"CORE - CORRECT ANSWER Comitte on Operating Rule Exchange"
"DOB - CORRECT ANSWER Date of Birth"
"DOS - CORRECT ANSWER Date of Service"
"Claims register - CORRECT ANSWER Tracks submitted claims and dates"
"Non-feasance - CORRECT ANSWER A failure to act when a person should"
"Signing for subpoena - CORRECT ANSWER Front desk cannot sign subpoena the provider has
to (office manager)"
"Stat - CORRECT ANSWER Something that is urgent"
"Stat referral - CORRECT ANSWER A type of referral that is requested from a facility to be dealt
with within 24 hours. Requires a phone call and fax to facility"
"Subpoena signing - CORRECT ANSWER Must be signed by the dr or office manager"
"Subpoena duces tecum - CORRECT ANSWER Court order to produce original records"
"Tracking unpaid documents - CORRECT ANSWER Make file marked unpaid vendors. Check bi-
weekly"
"Verifying insurance for walk-in patients - CORRECT ANSWER 1. Ask for demo infor;
- If schedule is available make appt today;
- If no appt. available call triage nurse"
"CPT publication is updated and revised - CORRECT ANSWER Annually"
"Largest section of the CPT book is the - CORRECT ANSWER Surgery section"
"What is the name of the book used in the physician's office to code procedures? - CORRECT
ANSWER Current Procedural Terminology CPT"
"Carcinoma in situ is used to describe - CORRECT ANSWER cancer that is confined to the site of
origin" "A working knowledge of___________and a Course in anatomy and physiology are Essential to
becoming a topnotch coder of Diagnoses - CORRECT ANSWER Medical Terminology"
"Diagnostic codes have from __ to __ digits - CORRECT ANSWER 3 to 5"
"CPT uses a basic __ digit system for coding services PLUS a __ digit add on modifier - CORRECT
ANSWER 5 and 2"
"Insurance companies go by the rule "if it is not documented, then it was not - CORRECT
ANSWER done or performed"
"Coding and billing numerous CPT codes to identify procedures that are usually Described by a
single code is called - CORRECT ANSWER Unbundling"
"Deliberate manipulation of CPT codes for increased payment is called - CORRECT ANSWER
upcoding" "A term used as the name of a disease, structure, operation, or procedure usually derived from
the name of a place or person who discovered or described it first is called a/an - CORRECT
ANSWER Eponym"
"Name 6 basic location methods to locate main terms in the index CPT - CORRECT ANSWER
Service, procedure, anatomic site, disease, synonym, eponym, abbreviation"
"Medical etiquette refers to - CORRECT ANSWER Consideration for others"
"AHIMA publishes - CORRECT ANSWER Diagnostic and procedure training code books and
diagnostic coding and reporting requirements"
"Reporting incorrect information to private insurance carriers is considered - CORRECT
ANSWER Unethical"
"Why are multi-skilled health practitioner's MSHP in demand - CORRECT ANSWER •They are
cross trained to provide more than one function. •They are often competent in more than one discipline. •They offer more flexibility to their employer."
"Medical ethics include - CORRECT ANSWER Standard of conduct"
"A self employed medical insurance biller that does independent contracting is responsible for -
CORRECT ANSWER Advertising, Billing, Accounting"
"When an insurance billing specialist bills for a physician and completes a Medicare claim form
with information that does not reflect the true situation - CORRECT ANSWER he/she may be
subject to fines and imprisonment"
"Billing for services or supplies not provided is - CORRECT ANSWER Fraud, illegal"
"A billing practice such as excessive referrals to other providers for unnecessary services is
considered - CORRECT ANSWER Medical billing abuse"
"Stealing money that has be entrusted to one's care is know as - CORRECT ANSWER
embezzlement" "Coined term by AHIMA's eHealth Task Force to describe transactions in which health care information is accessed, processed, stored, and transferred using electronic chronologies is
usually abbreviated as - CORRECT ANSWER EHIM {electronic health information
management}" "Individual designated to help a provider remain in compliance by setting policies and procedures in place, train staff regarding HIPAA, and act as the contact person for questions and complaints
CORRECT ANSWER •Privacy officer, •Privacy official"
"A health care coverage carrier, clearinghouse, or physician who transmits health information in
electronic for in connection with transaction covered by HIPAA is called - CORRECT ANSWER
Covered entity"
"What is the correct term to determine if a procedure is covered and medically necessary -
CORRECT ANSWER Pre-authorization"
"Obtaining and recording patient data before the person's first visit is known as - CORRECT
ANSWER Pre-registration"
"Discovering the maximum $ amount that the carrier will pay for a procedure is called -
CORRECT ANSWER predetermination"
"Criteria used by insurance companies when making decisions to limit or deny payment of medical services or procedures must be justified by the patient's symptoms and diagnosis are
called - CORRECT ANSWER medical necessity"
"If husband & wife both have insurance through their employers, and each has added the spouse to their primary insurance plans for coverage. If the wife is seen for treatment then her plan is
considered - CORRECT ANSWER Primary"
"The Health Insurance Claim Form, also know as universal claim form is often called - CORRECT
ANSWER CMS-1500"
"If a professional liability claim is filed by a patient, good helps establish a strong defense -
CORRECT ANSWER Documentation"
"Insurance claim submitted on paper - CORRECT ANSWER Paper claim"
"Insurance claim held in suspense due to review or other reason - CORRECT ANSWER Pending
claim"
"Insurance claim that is submitted via a dial- up modem or direct data entry - CORRECT
ANSWER Electronic claim"
"Cost pressures on health care providers are forcing employers to reduce personnel
costs by hiring - CORRECT ANSWER Multi skilled health care practitioners"
"Claims assistance professional - CORRECT ANSWER {CAP}- works for the consumer, helps
patients file insurance claims"
"In medical practice what is "cash flow" - CORRECT ANSWER Actual money available to a
medical practice"
"Front office medical duties have become increasingly important because - CORRECT
ANSWER Diagnostic and procedural coding must be review for its correctness and
completeness" "What level of education is generally required for one who seeks employment as an insurance
coder? - CORRECT ANSWER Completion of an accredited program for coding certification"
"What organization published diagnostic and procedure coding competencies for outpatient
services and diagnostic coding and reporting requirement for physician billing - CORRECT
ANSWER {AHIMA} American Health Information Management Association"
"Amount of money an insurance billing specialist earns is dependent on what - CORRECT
ANSWER •Knowledge
•experience •Size of employing institution"
"billing specialist is entrusted with - CORRECT ANSWER •Holding patients medical
information in confidence •Collecting monies •Being a reliable resource for co- workers" "Confidentiality between the physician and the patient is automatically waived when the patient
is being treated in a workers' compensation case - CORRECT ANSWER TRUE"
"A patient has the right to obtain a copy of his/her confidential health information - CORRECT
ANSWER TRUE"
"Confidential information includes - CORRECT ANSWER •Everything that is heard about a
patient •Everything that is read about a patient •Everything that is seen regarding a patient"
"Brackets - CORRECT ANSWER Used to enclose synonyms, alternative wording or and
explanatory phrase"
"Modifiers - CORRECT ANSWER Reporting indicators that indicate that the procedure or
service has been altered by specific circumstance but has not changed in it's definition of code."
"Medicare part A - CORRECT ANSWER Part A is hospital insurance provided by Medicare.
Most people do not pay a premium for this coverage."
"Medicare part B - CORRECT ANSWER Part B is medical insurance to pay for medically
necessary services and supplies provided by Medicare. (Doctors, outpatient care, Phys. and Occ. Therapists etc.)"
"Invalid Claim - CORRECT ANSWER Any Medicare claim that contains complete, necessary
information but is illogical or incorrect (e.g., listing an incorrect provider number for a referring physician). Invalid claims re identified to the provider and may be resubmitted"
"Advance Beneficiary Notice - (ABN) - CORRECT ANSWER A notice that a doctor, supplier, or
provider gives a Medicare beneficiary before furnishing an item or service if the doctor, supplier, or provider believes that Medicare may deny payment."
"Encounter form - charge ticket which contains ICD's - CPT codes - CORRECT ANSWER Form
generated in the office that provides the billers infor necessary to get reimbursement for insurance company"
"Worker's compensation cases (must have authorization before seeing patient) - CORRECT
ANSWER Dealing with a patient who was injured while working, the front desk must get the
case number assigned before the patient is seen - and the number of visits authorized"
"Basic Billing Reimbursement Steps - CORRECT ANSWER Patient Info, Verify Ins. Prepare
encounter form, Code DX & CPT, Review Linkage Protocol, Calculate physicians charges, Prepare claim, Transmit claim, Follow up on Reimbursement."
"Review Linkage Protocol - CORRECT ANSWER Appropriateness of Codes, Payers rules about
linkage, Documentation to support codes, Compliance with regulation and guidelines"
