NHA - Certified Billing and Coding
Specialist (CBCS) Study Guide
1. A billing and coding expert can make sure appropriate coverage insurance for an
outpatient procedure by using obtaining what? - ANS-Precertification
2. A declare may be denied or rejected for which of the following reasons? - ANS-Block
24D incorporates the analysis code
3. A coroner's autopsy is comprised of what examinations? - ANS-Gross Examination
4. A patient's health plan is called the "payer of last motel." What is the name of that health
plan? - ANS-Medicaid
5. Abstracting - ANS-The extraction of precise statistics from a medical file, often for use in
an outside database, inclusive of a cancer registry.
6. Abuse - ANS-Practices that directly or in a roundabout way result in pointless expenses
to the Medicare software.
7. Account Number - ANS-Number that identifies specific episode of care, date of provider,
or patient.
8. Accounts Receivable Department - ANS-Department that keeps track of what third-party
payers the company is waiting to listen from and what patients are because of make a
payment.
9. Advance Beneficiary Notice of Noncoverage - ANS-Form supplied if a issuer believes
that a provider can be declined due to the fact Medicare may don't forget it pointless.
10. Aging Report - ANS-Measures the outstanding balances in every account.
11. Allowable Charge - ANS-The amount an insurer will accept as complete payment, minus
applicable fee sharing.
12. Ambulatory surgical treatment centers, domestic health care, and hospice groups use
which shape to put up claims? - ANS-UB-04 Claim Form
13. APC Grouper - ANS-Helps coders decide the appropriate ambulatory price category
(APC) for an outpatient come across.
14. As of April 1, 2014 what is the maximum number of diagnoses that may be said at the
CMS-1500 claim shape before a similarly claim is required? - ANS-12
15. Assignment of Benefits - ANS-Contract wherein the issuer immediately bills the payer
and accepts the allowable charge.
16. At how many should a the front torso burn be coded? - ANS-18%
17. Auditing - ANS-Review of claims for accuracy and completeness.
18. Authorizations - ANS-Permission granted via the affected person or the affected person's
consultant to launch information for reasons aside from remedy, fee, or health care
operations.
19. Balance Billing - ANS-Billing patients for fees in excess of the Medicare rate schedule.
20. Batch - ANS-A group of submitted claims.
, 21. Block 17b at the CMS-1500 declare shape have to list what data? - ANS-Referring
health practitioner's country wide provider identifier wide variety.
22. Business Associate (BA) - ANS-Individuals, businesses, or groups who are not
contributors of a blanketed entity's workforce that carry out functions or activities on
behalf of or for a included entity.
23. By signing block 12 of CMS-1500 shape, a affected person is doing what? -
ANS-Authorizes the discharge of medical facts.
24. Category I CPT Code - ANS-Code that covers physicians' services and sanatorium
outpatient coding.
25. Category II CPT Code - ANS-Code designed to serve as supplemental monitoring codes
that may be used for performance size.
26. Category III CPT Code - ANS-Code used for temporary coding for brand new generation
and offerings which have not met the necessities had to be brought to the primary
section of the CPT e book.
27. Charge description Master (CDM) - ANS-Information about fitness care offerings that
patients have obtained and economic transactions that have taken region.
28. Claim - ANS-Complete file of the services furnished with the aid of the health care
professional, along with suitable coverage data.
29. Clean Claim - ANS-Claim that is correct and entire. They have all of the information
needed for processing, that is completed in a well timed fashion.
30. Clearinghouse - ANS-Agency that converts claims into standardized electronic layout,
looks for mistakes, and codecs them in keeping with HIPAA and insurance standards.
31. Coinsurance - ANS-the pre-established percent of charges paid through the coverage
organisation after the deductible has been met.
32. Computer-assisted Coding (CAC) - ANS-Software that scans the entire patient's digital
record and codes the stumble upon based at the documentation in the file.
33. Conditional Payment - ANS-Medicare fee that is recovered after number one insurance
pays.
34. Consent - ANS-A affected person's permission evidenced by signature.
35. Coordination of Benefits Rules - ANS-Determines which coverage plan is number one
and which is secondary.
36. Copayment - ANS-A constant greenback quantity that should be paid on every occasion
a patient visits a company.
37. Cost Sharing - ANS-The stability the policyholder have to pay the company.
38. CPT codes are used to describe what? - ANS-Services rendered by the company.
39. Crossover Claim - ANS-Claim submitted by using people covered through a number one
and secondary insurance plan.
40. De-diagnosed Information - ANS-Information that does not discover an character
because specific and private characteristics had been eliminated.
41. Deductible - ANS-The amount of cash a affected person m just pay out of pocket before
the insurance enterprise will begin to pay for covered blessings.
42. Dirty Claim - ANS-Claim that is inaccurate, incomplete, or contains other errors.
43. E Codes - ANS-Codes used to categorise environmental occasions, occasions, and
conditions, including the motive of harm, poisoning, and different damaging events.
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