NHA CBCS EXAM REVIEW Latest 2022 2023 Questions and Correct Answers A beneficiary of a Medicare/Medicaid crossover claim submitted by a participating provider is responsible for which of the following percentages? - Ans 0%
A billing and coding specialist can ensure appropriate insurance coverage for an outpatient procedure by first using which of the following processes? - Ans Precertification
A billing and coding specialist can ensure appropriate insurance coverage for an outpatient procedure by first using which of the following processes? - Ans Precertification **Precertification is the first step. Preauthorization is a decision from the payer to approve the service. It is not the first step to determine insurance reimbursement.
A billing and coding specialist has four past do payments, which one goes to collections first? - Ans The largest past-due charge
A billing and coding specialist has four past-due charges: $400 that is 10 weeks past due; $800 that is 6 weeks past due; $1,000 that is 4 weeks past due; and $2,000 that is 8 weeks past due.Which of the following charges should be sent to collections first? - Ans $2,000
A billing and coding specialist is preparing a claim form for a provider from a group practice.The billing and coding specialist should enter the rendering provider's national provider identifier (NPI) into which of the following blocks on the CMS-1500 claim form? - Ans Block 24J
A billing and coding specialist is reviewing a CMS-1500 claim form. The "assignment of benefits box has been checked yes. The checked box indicates which of the following? - Ans The provider receives payment directly from the payer
A billing and coding specialist needs to know how much Medicare paid on a claim before billing the secondary insurance. Which of the following should the specialist refer? - Ans Remittance Advice
A billing and coding specialist should routinely analyze which of the following to determine the number of outstanding claims? - Ans Aging report
A billing and coding specialist should understand that the financial record source that is generated by a provider's office is called a? - Ans Patient Ledger Account
A billing and coding specialist submitted a claim to Medicare electronically. No errors were found by the billing software or clearinghouse. Which of the following describes this claim? - Ans Clean claim
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A claim is denied because the service was not covered by the insurance company. Upon confirmation of no errors on the claim, which of the following describes the process that will follow the denial? - Ans The claim will not be resubmitted and the patient will be sent a bill
A claim is denied due to termination of coverage. Which of the following actions should the billing and coding specialist take next? - Ans Follow up with the patient to determine current name, address, and insurance carrier for resubmission
A coding specialist should use which modifier to report a bilateral procedure? - Ans -50
A coding specialist should use which modifier to report multiple procedures? - Ans -51
A coding specialist should use which modifier to report reduced services? - Ans -52
A coroner's autopsy is comprised of which examination? - Ans Gross examination
A form that contains charges, DOS, CPT codes, ICD-10-CM, fees, and copayment information is a? - Ans Encounter form
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
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? - Ans $230 **A non-PAR who does not accept assignment, can collect a maximum of 15% (the limiting charge) over the non-PAR Medicare fee schedule amount.
A new patient is: - Ans One who has not visited the physician in more than 3 years
A participating BCBS provider received an EOB for a patient account. The charged amount was $100. BCBS allowed $80 and applied $40 to the patients annual deductible. BCBS paid the balance at 80%. How much should the patient expect to pay? - Ans 48
A patient has AARP as secondary insurance. In which of the following blocks on the CMS-1500 claim form should the information be entered? - Ans Block 9
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? - Ans Worker's compensation
A patient is diagnosed with metastatic bone neoplasm. The neoplasms will be coded as? - Ans Secondary malignant
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