NHA CBCS | Questions and Verified Answers| 100% Correct| A Grade (2024/ 2025)
QUESTION
A claim is denied because the service was not covered by the
... [Show More] insurance company. Upon confirmation of no errors on the claim, which of the following describes the process that will follow the denial?
Answer:
the claim will not be re-submitted and the patient will be sent a bill
QUESTION
Which of the following statements is true when determining patient financial responsibility by reviewing the remittance advice?
Answer:
any coinsurance, copayments, or deductibles can be collected from the patient
QUESTION
Which of the following is the appropriate diagnosis for a patient who has an abnormal accumulation of fluid in her lower leg that has resulted in swelling?
Answer:
edema
QUESTION
Patient charges that have not been paid will appear in which of the following?
Answer:
accounts receivable
QUESTION
Which of the following was developed to reduce Medicare program expenditures by detecting inappropriate codes and eliminating improper coding practices?
Answer:
NCCI
QUESTION
Test results indicated that no abnormalities were found in the brain and the brain's electrical activity patterns are normal. Which of the following tests was used to conduct this exam?
Answer:
EEG
QUESTION
Which of the following is the third stage of the life cycle of a claim?
Answer:
claim adjudication
QUESTION
Which of the following describes the content of a medical practice aging report?
Answer:
an overview of the practice's outstanding claims
QUESTION
Which of the following situations constitutes a consultation?
Answer:
services rendered by a physician whose opinion or advice is requested by another physician or agency
QUESTION
A patient has an emergency appendectomy while on vacation. The claim is rejected due to the patient obtaining services out-of-network. Which of the following information should be included in the claim appeal?
Answer:
the patient was out-of-town during the emergency
QUESTION
Which of the following is a verbal or written agreement that gives approval to release protected health information (PHI)?
Answer:
Consent
QUESTION
HIPAA transaction standards apply to which of the following entities?
Answer:
health care clearinghouse
QUESTION
Which of the following organizations identifies improper payments made on CMS claims?
Answer:
Recovery audit contractor (RAC)
QUESTION
For which of the following time periods should the billing and coding specialist track unpaid claims before taking follow-up action?
Answer:
30 days
QUESTION
Which of the following is the initial step in processing a worker's compensation claim?
Answer:
first report of injury
QUESTION
Which of the following information is required to include on an Advance Beneficiary Notice (ABN) form?
Answer:
the reason Medicare may not pay
QUESTION
Behavior plays an important part of being a team player in a medical practice. Which of the following is an appropriate action for the billing and coding specialist to take?
Answer:
communicating with the front desk staff during a team meeting about missing information in patient files
QUESTION
Which of the following is the portion of the account balance the patient must pay after services are rendered and the annual deductible is met?
Answer: [Show Less]