NHA CBCS EXAM REVIEW 2024 | 220 QUESTIONS AND CORRECT VERIFIED ANSWERS |NHA CBCS REVIE EXAM LATEST 2024/2025/ALREADU GRADED A+ Which of the following Medicare policies determines if a particular item or service is covered by Medicare? –ANSWER National Coverage Determination (NCD) A patient's employer has not submitted a premium payment. Which of the following claim statuses should the provider receive from the third -party payer? – ANSWER Denied A billing and coding specialist should routinely analyze which of the following to determine the number of outstanding claims? ANSWER - Aging report Which of the following should a billing and coding specialist use to submit a claim with supporting documents? - ANSWER Claims attachment Which of the following terms is used to communicate why a claim line item was denied or paid differently than it was billing? - ANSWER Claim adjustment codes On a CMS -1500 claim form, which of the following information should the billing and coding specialist enter into Block 32? - ANSWER Service facility location information A provider's office receives a subpoena requesting medical documentation from a patient's medical record. After confirming the correct authorization, which of the following actions should the billing and coding specialist take? ANSWER -Send the medical information pertaining to the dates of service requested Which of the following is the deadline for Medicare claim submission? -
ANSWER 12 months from the date of service Which of the following forms does a third -party payer require for physician services? - ANSWER CMS -1500 A patient who is an active member of the military recently returned from overseas and is in need of specialty care. The patient does not have anyone designed with power of attorney. Which of the following is considered a HIPAA violation? – ANSWER The billing and coding specialist sends the patient's records to the patient's partner. Which of the following terms refers to the difference between the billing and allowed amounts? - ANSWER Adjustment Which of the following HMO managed care services requires a referral? – ANSWER Durable medical equipment Which of the following explains why Medicare will deny a particular service or procedure? ANSWER -Advance Beneficiary Notice (ABN ) Which of the following types of claims is 120 days old? -? ANSWER Delinquent When reviewing an established patient's insurance card, the billing and coding specialist notices a minor change from the existing card on file. Which of the following actions should the billing and coding specialist take? -? ANSWER Photocopy both sides of the new card 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? ANSWER -The wife's insurance Which of the following would most likely result in a denial on a Medicare claim? -? ANSWER an experimental chemotherapy medication for a patient who has stage III renal cancer Which of the following pieces of guarantor information is required when establishing a patient's financial record? ANSWER -Phone number A provider surgically punctures through the space between the patient's ribs using an aspirating needle to withdraw fluid from the chest cavity. Which of the following is the name of this procedure? -ANSWER Pleurocentesis A patient has AARP as secondary insurance. In which of the following blocks on the CMS -1500 claim form should the information be entered? -ANSWER Block 9 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? - ANSWER $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.
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