NHA CBCS Exam
Quiz yourself by thinking what should be in
each of the black spaces below before clicking
on it to display the answer.
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| show | Standards of conduct based on moral principals. Acting within ethical behavior boundries means carrying out one's responsibilities with integrity, decency, respect, honesty, competence, fairness and trust.
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| Compliance Regulations | show 🗑
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| show | Health Insurance Portability and Accountability Act of 1996.
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| show | Medical Procedures
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| show | Supplemental Codes for Performance Measures
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| show | Emerging Technologies
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| Add on Codes | show 🗑
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| show | 00100-01999, 99100-99140
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| Evaluation and Management (E&M) codes | show 🗑
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| Brackets | show 🗑
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| Bullets | show 🗑
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| show | The reason the patient came to see the physician.
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| show | exemption from modifier 51
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| CPT | show 🗑
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| E&M Codes | show 🗑
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| show | At the beginning of each section and used to provide specific coding rules for that section.
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| History (HX) | show 🗑
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| History of Present Illness (HPI) | show 🗑
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| show | Listed under associate and stand alone codes
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| E Codes | show 🗑
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| Level 1 codes | show 🗑
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| Level 2 codes | show 🗑
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| Level 3 codes | show 🗑
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| The List of Modifiers is found where in the CPT | show 🗑
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| Modifier 50 | show 🗑
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| show | Attach to E/M service code when service is provided during postoperative period to indicate the the service is not part of postoperative care and not included in the Surgical Package
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| Modifier 26 | show 🗑
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| Modifier 51 | show 🗑
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| Modifier 57 | show 🗑
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| Modifier 78 | show 🗑
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| show | Procedure or service provided during postoperative period not associated with initial procedure.
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| Modifiers | show 🗑
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| Parentheses | show 🗑
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| Past, Family and Social History (PFSH) | show 🗑
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| Pathology and Laboratory | show 🗑
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| show | add on codes
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| show | 77010-79999
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| Review of Symptoms (ROS) | show 🗑
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| Stand Alone Codes | show 🗑
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| Sideways triangle means | show 🗑
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| show | new procedure code
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| show | modifier 51 exempt code
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| Six sections of CPT | show 🗑
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| Three Components for E*M Codes | show 🗑
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| Three Catagories for E*M Codes | show 🗑
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| 4 contributing factors for E&M Codes | show 🗑
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| Medicare part A | show 🗑
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| Medicare part B | show 🗑
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| show | Part C is the combination of Part A and Part B. The main difference in Part C is that it is provided through private insurance companies approved by Medicare.
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| Medicare part D | show 🗑
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| show | free or low-cost health insurance coverage through the state
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| show | A distinction for individuals who fall into a specific category (or criteria)of mandatory Medicaid eligibility established by the federal government. These categories apply to every state Medicaid program.
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| Medicaid Medically Needy | show 🗑
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| Who is the Payer of Last Resort? | show 🗑
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| show | health care program for Uniformed Service members, retirees and their families
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| TRICARE STANDARD | show 🗑
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| TRICARE EXTRA (PP0) | show 🗑
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| TRICARE PRIME (HMO) | show 🗑
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| CHAMPVA | show 🗑
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| show | Private individuals are responsible for securing their own health insurance coverage. Commercial Government, Employer, Group health insurance coverage
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| Group Health Plans | show 🗑
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| show | Health indemnity insurance is a fee for service insurance that is sometimes used when a person is in between health plans, and will cover some (but not all) expenses
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| HMO | show 🗑
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| show | PPO is similar to an HMO, but care is paid for as received instead of in advance in form of a schedule. PPOs may offer more flexibility by allowing for visits to out-of-network professionals. Visits within network require only the payment of a small fee.
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| POINT OF SERVICE | show 🗑
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| Disability Insurance | show 🗑
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| Workman's Comp | show 🗑
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| show | refer to the base amount that is treated as the standard or most common charge for a particular medical service when rendered in a particular geographic area.
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| Relative Value Payment Method | show 🗑
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| Medicare Resource Based Relative Value Unit (RVU) Payments/Components | show 🗑
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| Clean Claim | show 🗑
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| Dirty Claim | show 🗑
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| Invalid Claim | show 🗑
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| show | A rejected claim is an electronically submitted claim that is unprocessable due to missing or invalid information required by the payer.
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| show | a notice that a doctor, supplier, or provider gives a Medicare beneficiary before furnishing an item or service if the doctor, supplier, or provider believes that Medicare may deny payment.
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| show | An insurance claim submitted on paper, including those opticaly scanned and converted to an electronic form by the insurance carrier
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| show | An insurance claim submitted to the insurance carrier via a central processing unit (CPU), tape, diskette, direct data entry, direct wire, dial-in telephone, digital fax, or personal computer download or upload
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| show | Developed by the AMA and the Centers for Medicare and Medicaid Services (CMS). Used by physicians and other professionals to bill outpatient services and supplies to Tricare, Medicare, some Medicaid programs, and some private insurance/managed care plans
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| show | Patient Info, Verify Ins. Prepare encounter form, Code DX & CPT, Review Linkage Protocol, Calculate physicians charges, Prepare claim, Transmit claim, Follow up on Reimbursement.
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| show | Appropriateness of Codes, Payers rules about linkage, Documentation to support codes, Compliance with regulation and guidelines
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| Life Cycle of a Claim | show 🗑
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| show | Medicare Administrative Contractor
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| "A condition that develops after, the outpatient care has been provided or during an inpatient admission." | show 🗑
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| "A concurrent condition that coexists with the first-listed diagnosis or principal diagnosis, has potential to affect treatment of the aforementioned diagnosis and is an active condition for which the patient is treated and/or monitored." | show 🗑
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| show | Preauthorization
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| show | Accounts Receivable (A/R)
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| show | Accounts Payable (A/P)
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| show | Hypertension
Neoplasm
Table of Drugs and Chemicals
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| show | Remittance Advice
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| Billing a patient for the difference between a higher usual fee and a lower allowed charge is called _____________. | show 🗑
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| show | Medicare
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| A health-benefit program designed for low-income, blind, or disabled patients; needy families; foster children; and children born with birth defects. | show 🗑
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| What is the single largest healthcare program in the United States? | show 🗑
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| Signed into law in 2010, an act that resulted in improved access to affordable healthcare coverage and protection from abusive practices by healthcare insurance companies is what? | show 🗑
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| show | Guarantor
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| Medicare beneficiaries can also obtain supplemental insurance called what? | show 🗑
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| show | Helps cover costs not reimbursed by the original Medicare plan.
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| A writ requiring the appearance of a person at a trial or other proceeding is a ___________. | show 🗑
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| When does the tertiary insurance pay? | show 🗑
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| show | A numeric and alphabetic coding system used for billing/pricing of procedures, medical supplies, medications, and durable medical equipment (DME).
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| A managed care organization that establishes a network of providers who care for their patients is called a/an _________. | show 🗑
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| show | Clearinghouse
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| The out-of-pocket payment amount that a policyholder must meet before insurance covers the service(s) is called? | show 🗑
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| National Provider Identifier (NPI) number | show 🗑
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| show | A payment structure in which a health maintenance organization prepays an annual set fee per patient to a physician.
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| A fixed fee collected at the time of the patients visit. | show 🗑
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| show | Coinsurance
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| show | Premium
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| Coding and billing that is inconsistent with typical coding and billing practices. | show 🗑
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| How does HIPAA define fraud? | show 🗑
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| show | Intent
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| show | Numeric codes developed by the American Medical Association (AMA) to standardize medical services and procedures.
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| Is Abuse intentional? | show 🗑
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| show | Roster Billing
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| show | Claimant
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| show | Liability Insurance
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| show | Remittance Advice (RA)
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| show | Assignment of Benefits
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| A/An ___________ is a person admitted to a hospital or long-term care facility(LTCF) for treatment with the expectation that the patient will remain in the hospital for a period of 24 hours or more. | show 🗑
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| show | Involves restricting patient information access to those with proper authorization and maintaining the security of patient information.
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| show | Principal diagnosis
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| Physicians who enroll in managed care plans are called ______________. They have contracts with Managed Care Organizations (MCO)s that stipulate their fees. | show 🗑
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| show | Compliance Plan
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| show | The Medicare Catastrophic Coverage Act of 1988
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| Transmitting electronic medical insurance claims from providers to payers using the necessary information systems is called ______________. | show 🗑
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| show | Malignant
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| show | Benign
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| show | Unspecified
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| show | Comorbidities and Complications
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| What does policy mean? | show 🗑
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| A person who receives a check in payment is the _________. | show 🗑
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| Insurer/Insured, Subscriber, Member, Recipient are all terms that apply to the? | show 🗑
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| True or False, Preferred Provider Organizations (PPO)s never allow members to receive care from physicians outside the network. | show 🗑
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| Everything a medical claims specialist learns about a patient's condition must remain _____________. | show 🗑
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