NHA NEW CBCS PRACTICE TESTS- study Questions and Answers (2024 / 2025) (Verified Answers)
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NHA NEW CBCS PRACTICE TESTS- study Questions and Answers (2024 / 2025) (Verified Answers)
Medical Ethics
Standards of conduct based on moral principles. Generally accepted as a guide for behavior towards patients, physicians, co-workers, the government, and insurance compaines.
Compliance Re...
NHA NEW CBCS PRACTICE TESTS- study Questions
and Answers () (Verified Answers)
Medical Ethics
Standards of conduct based on moral principles. Generally accepted as a guide for behavior towards
patients, physicians, co-workers, the government, and insurance compaines.
Compliance Regulations
billing-related cases are based on HIPAA and False Claims Act.
Health Insurance Portability and Accountability Act of 1996 (HIPPA)
Created the Health Care Frad and Abuse Control Prpgram enacted nt check for fraud and abuse in the
Medicare and Medicaid programs, and private payers.
Two provisions of HIPPA
Titile I: Insurance Reform
Title II: Administrative Simplification
Insurance Reform. -Primary purpose to provide continuous insurance coverage for workers and their
dependents when they change or lose their jobs.
-Limits the use of preexisting conditions exclusions
-Prohibits discrimination for part or present poor health
-Guarantees cetraom employees and individuals the right to purchase health insurance coverage after
losing a job
- Allows renewal of health insurance coverage regardless of an individual's health condition that is
covered under the particular policy
Administrative Simplification-The goal is to focus on the health care practice setting to reduce
administrative cost and burdens.
Two parts:
1. Development and implementation of standardized health-related financial and administrative
activities electronically.
2. Implementation of privacy and security procedures to prevent the misuse of health information by
ensuring confidentiality.
False Claim Act (FCA)
Federal law that prohibits submittimg a fraudulent claim or making statement or representation in
connection with a claim.
National Correct Coding Initiative (NCCI)
Developed by the CMS to promote national correct coding methodologies and to control improper
coding that leads to inappropriate payment of part B health insurance claims.
Two type of NCCA edits - 1. Column 1 /Column 2 or Comprehensive Component Edits: identifies code
pairs that should not be billed together because one code. Column 1 includes all the services
described by another code in Column 2.
2. Mutually Exclusive Edits: identifies code pairs that, for clinical reason, are unlikely to be performed
on the same patient on the same day.
,Office of Inspector General (OIG)
Investigates and prosecute health care fraud and abuse.
Fraud
Knowingly and intentionally deceiving or misrepresenting information that may result in unauthorized
benefits.
Abuse
Defined as incidents or practices, not usually considered fradulaent that are inconsistant with the
accepted medical business or fiscal practices in the industry.
Patient Confidentiality- All patients have the right to privacy, and all information should remain
privileged.
Discuss patient information with only the patient's physician or office personnel that need cetain
information to do their job. Obtained a signed consent form to release medical infomation to the
insurance company or other individual.
Under HIPPA Privacy Rule, providers may use patient's Protected Health Information (PHI) without
specific authorization for
Treatment: primarily for the purpose of discussion fo the patient's case with other providers.
Payment: providers submit claims on behalf of patients.
Operations: for purposes such as stafff training and quality improvment.
Employern Liability
Physicians are legally responsible for their own conduct and any action of their employees (their
designee) perform within the context of their employment. Refered to as "vacarious liability"also
known as "respondent superior" which means "let the master answer".
Employee Liabiltiy
"Errors and omissions insurance" is protection against loss of monies by failure through error or
unintentional omission on the part of the individual or service submitting the insurance claim.
Medical Records
Documentaiton of the patient's social and medical history, family history, physical examination
findings, progress notes, radiology, and lab results, consultation reports, and correspondence to
patient.
Information needed when billing the insurance company
Date of service (DOS), place of service (POS), type of service (TOS), diagnosis (dx or DX), and
procedures.
Retention of Medical Records
Governed by state and local laws and may bary from state-to-state. Most physicians are required to
retain records indefinitley; deceased patient records should be kept for at least (5) years.
New patient
,one who has not received any medical services within the last 3 years
Established patient
someone who has received medical services in the last 3 years from the physician or another
physician of the same specialty who belong to the same group practice.
cheif complaint
brief statement describing they symptom, problem, diagnosis, or condition that is the reason a
patient seeks medical care.
3 volumns of ICD-9 manal
Volumn 1-Diseases: Tabular List
Volumn 2-Diseases: Alphabetic Index
Volumn 1 and 2 are used in the inpatient and outpatient setting
Volumn 3- Procedures:Tabular List and Alphabetic Index
Volumn 1 - Diseases: Tabular List
-contains the diease and condition code and the descriptions
- also contains the V codes and E codes
Volumn 2 - Diseases: Alphabetic Index
alphabetic index of volumn 1
Volumn 3 - Tabular List and Alphabetic Index
contains codes for surgical, therapeutic, and diagnostic procedures; used primarily by hospitals
Hypertension classifications:
Maligant- an accelerated, severe form of hypertension with vascular damage and a diastolic pressure
of 130mmHg or greater.
Benign- Mild or controlled hypertension and no damage to the vascular system or organs.
Unspecified- not specified as bengin or malignant in the diagnosis or medical record.
malignant neoplasm
further classified as to primary , secondary, or cacinoma in situ
primary malignancy
original cancer site. Malignant tumors are considered primary unless documented as secondary or
metastatic
carcinoma in situ
cancer that is localized and has not spread to adjacent tissue or distant parts of the body
secondary malignacy
cancer that has metasized (spread) to a secondary site either adjacent or remote region of the body
, 3 sections of Alphabetic index
Section 1: Index to Diseases: each term is followed by the code or codes that apply to that term
Section 2: Table of Drugs and Chemiclas: contains list of drugs and chemicals with corresponding
poisoning codes and E codes.
Current Procedural Terminology (CPT)
Codes used to report services and procedures by physicians.
Published and updated anually by the American Medical Association (AMA) with a new one coming
out each November and becoming effective on January 1st of the following calendar year.
Category I codes
respresent services and procedures widely used by many health care professional in clinical practice
in multiple locations and have been approved by the FDA
Category II codes
supplemental codes used for performance measurements.
Category III codes
temporary codes for emerging technology, services and procedures. If a Category III code is available,
it is reported instead of a Category I unlisted code.
stand-alone code
contain the full description of the procedure for the code
indented codes
codes are listed under associated stand-alone codes. To complete the description for indeneted
codes, one must refer to the portion of the stand alone code description before the semi-colon
add-on codes
used for procedures that is always performed during the same operative session as another surgery in
addition to the primary service/procedure and is never performed separatley.
Never stand alone, they are always reported in addition to a primary procedure code.
Modifier -51 (multiple procedures) exempt
modifiers
provide the means by which the reporting physician can indicate that a service or procedurethat has
been performed has been altered by some specific circimstance but not change in its definition or
code.
A triangle
symbol in the CPT manual that represents a change in the code description since the last edition. The
change may be minor or significant and it could be and addition, deletion or revision.
Two trianguar symbols
represents changes in the text or definition between the triangles
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