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NHA CBCS Practice Questions (Set 2): 1. Which of the following is considered Protected Health Information (PHI) under the Health Insurance Portability and Accountability Act (HIPPA)?: Patient's$9.99
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NHA CBCS Practice Questions (Set 2): 1. Which of the following is considered Protected Health Information (PHI) under the Health Insurance Portability and Accountability Act (HIPPA)?: Patient's
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Course
NHA CBCS
Institution
NHA CBCS
NHA CBCS Practice Questions (Set 2):
1. Which of the following is considered Protected Health Information (PHI) under the Health Insurance Portability and Accountability Act (HIPPA)?: Patient's
1. Which of the following is considered Protected Health Information (PHI) un- der the Health Insurance
Portability and Accountability Act (HIPPA)?ANS
Patient's email address
2. Emily, a 45-year old patient, has recently been diagnosed with a chronic condition that requires ongoing
treatment. Her primary insurance is through her employer, but she also has a secondary insurance through her
spouse's employer. When submitting claims for Emily's treatment, what is the correct order of billing to
ensure proper coordination of benefits?ANS
Submit the claim to the primary insurance first, then the secondary insurance
3. Dr. Smith preformed a minor surgical procedure on John Doe at an out- patient surgery center. Which
place of service code should be used for this procedure?ANS
24- procedures performed in an ambulatory surgery center ASC)
4. Sarah, a medical billing specialist, is reviewing the account of a patient named John Doe. She notices
that the insurance company has a lack of
pre-authorization for a specific procedure. What is the best course of action for Sarah to take to resolve this
issue?ANS
Obtain the necessary pre-authorization and then resubmit the claim
5. Dr. Smith is submitting a CMS-1500 claim form for patient named John Doe, who received outpatient
services covered by medicare. Which section of the CMS-1500 form should Dr. Smith complete to indicate the
type of insurance plan covering John Doe?
- Box 1a- insured's ID Number
- Box 11- Insured Policy Group or FECA number
- Box 1- Insurance Type
- Box 24- Service Line InformationANS
Box 1- Insurance Type
6. Which of the following is a primary purpose of internal audits in the context of medical billing and
coding?ANS
To identify the correct coding errors before claim submissions
7. Dr. Smith's office received a request from John Does insurance company for his medical records to process
a claim. According to HIPPA regulations, what is the most appropriate action for Dr. Smith's office to take?ANS
Provide only the minimum necessary information required to process the claim
8. When coding for Obstetrics, which of the following codes is used to indicate a routine prenatal visit with no
complications?
- Z34.00ANS
Routine prenatal for normal first pregnancy no complications
- O09.89ANS
Supervision of high risk pregnancy
- Z33.1ANS
Encounter for pregnancy test
- O10.11ANS
Pre-existing hypertension complicating pregnancyANS
Z34.00ANS
Routine prenatal for normal first pregnancy no complications
, NHA 2024-2025 CBCS Practice Questions (Set 2):
9. Sarah, a patient. has recently filled for bankruptcy. As a medical billing specialist, what is the
appropriate action to take regarding her outstanding medical bills?ANS
Cease all collection activities and notify the bankruptcy court
10. When coding for telemedicine services, which modifier should be append- ed to indicate the service was
provided via Telehealth?ANS
Modifier 95
11. When a patient has multiple insurance plans, which insurance plan is typically considered the primary
insurance?ANS
The insurance plan provided by the patients employer
12. Sarah, a medical billing specialist, is verifying insurance eligibility for a patient named John who has
a commercial insurance plan. Which of the following is a requirement she must fulfill to ensure that John's
insurance
eligibility is verified correctly?ANS
Confirm the patient's policy number and group number
13. Which of the following is the most crucial step in ensuring all applicable charges are captured for optimal
reimbursement?ANS
Reviewing patient encounter forms and progress notes
14. Sarah, a patient with a PPO insurance plan, needs to undergo a specialized surgery. Her preferred surgeon is
out-of-network. Which of the following steps should Sarah take to understand her out-of-network coverage and
potential costs?ANS
Contact her insurance company to verify out-of-network benefits and obtain pre-authorization
15. What is the first step in the insurance eligibility and benefits verification process?ANS
Verifying a patient's insurance coverage
16. Sarah visits her primary care physician for a routine check-up. Her insur- ance plan has 20% coinsurance
rate after meeting a $200 deductible.The total bill for the visit is $500 , and Sarah has already met her
deductible for the year.How much is Sarah responsible for paying out-of-pocket for this visit?
- $100
- $200
- $300
- $400ANS
$100
17. When coding for a total knee arthroplasty in an orthopedic speciality, which of the following CPT
codes is the most appropriate?ANS
27447
18. What is the primary purpose of a deductible in a health insurance policy?-
ANS
To ensure the patient shares in the cost of their healthcare services
19. Which of the following government insurance plans primarily covers indi- viduals aged 65 and older, as
well as certain individuals with disabilities?ANS
- Medicare
, NHA 2024-2025 CBCS Practice Questions (Set 2):
20. Mr. Johnson, a 68-year old patient, is enrolled in Medicare. He needs a com- prehensive understanding of his
coverage options. Which part of Medicare will cover his inpatient hospital stay if he is admitted for a surgical
procedure?ANS
- Medicare Part A
21. Dr. Smith performed a laparoscopic cholecystectomy on a 45-year old patient named John Doe. The
procedure was uncomplicated, and the patient was discharged the same day. Which CPT code should be used to
accurately represent the procedure?ANS
47562ANS
Uncomplicated laparoscopic cholecystectomy
22. Sarah, a medical billing and coding specialist, is verifying insurance el- igibility for a new patient, John
Doe, who has recently switched to a new insurance provider. What is the most crucial piece of
documentation Sarah needs to ensure John's insurance coverage is valid before proceeding with the billing
process?ANS
A copy of John's new insurance card
23. Dr. Smith is submitting a CMS-1500 claim form for his patient John Doe, who received outpatient
services. Which field should Dr. Smith use to indicate the diagnoses code for John Doe's condition?ANS
Field 21
24. What is the primary purpose of verifying a patient's insurance eligibility and benefits before rendering
services?ANS
To ensure the services will be covered by the patient's insurance
25. Dr. Smith documents that his patient John Doe, has been diagnosed with acute myocardial infarction
(AMI) and has undergone a percutaneous coro- nary intervention (PCI) with stent placement.Which of the
following ICD-10-CM codes would be most appropriate to abstract from his clinical documenta- tion?ANS
I21.01ANS
Acute Myocardial Infarction of the left descending coronary artery
26. Which of the following is the most accurate step to ensure that a claim is transmitted correctly to a
payer?ANS
Ensure that all required fields are completed and the claim is error-free.
27. Dr. Smith is evaluating a new patient, John Doe, who presents with multiple chronic conditions, including
diabetes and hypertension. The visit involves
a comprehensive history, comprehensive examination, and high complexity medical decision making. Based on
the key components and coding guide- lines, which E/M code is most appropriate for this visit?ANS
99205ANS
New patient visit involving a comprehensive history, comprehensive examination, and high complexity
28. Sarah a 45-year old patient, needs a knee replacement surgery. Her in- surance plan requires prior
authorization for all major surgeries. The medical billing specialist at the clinic submits the authorization
request but receives denial due to missing documentation. What is the most appropriate next step for the
medical billing specialist to take?ANS
Review the denial notice, gather the required documentation, and resubmit the authorization request
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