NHA Medical Billing & Coding (CBCS) Practice Test

Preguntas de práctica de ejemplo

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1. 1. Coding

   In ICD-10-CM, what does the abbreviation NOS in the Alphabetic Index or Tabular List indicate?

   • a.The documentation is unspecified, so an 'unspecified' code is assigned
   • b.The code requires an additional character to be complete
   • c.Two separate codes must be combined into one
   • d.The condition should never be coded as a primary diagnosis

   Respuesta: a

   Explicación: NOS stands for 'not otherwise specified' and is equivalent to 'unspecified.' It is used when the medical record lacks the detail needed to assign a more specific code. Coders should query the provider when greater specificity is clinically documented but not captured.

2. 2. Billing & Claims

   Medicare Part A primarily covers:

   • a.Physician office visits
   • b.Vision and dental care
   • c.Inpatient hospital, skilled nursing facility, hospice, and some home health care
   • d.Outpatient prescription drugs

   Respuesta: c

   Explicación: Medicare Part A is hospital insurance covering inpatient hospital stays, skilled nursing facility care, hospice, and limited home health services. Part B covers outpatient and physician services, and Part D covers prescription drugs. Knowing which part applies is essential for correct claim routing.

3. 3. Reimbursement

   A patient owes a $40 copay and has 20% coinsurance on an allowed amount of $250 after the copay does not apply to coinsurance. If the deductible is already met, what does the payer pay on the $250 allowed amount (coinsurance portion only)?

   • a.$200, which is 80% of the $250 allowed amount
   • b.$50, which is the coinsurance owed by the patient
   • c.$250, the full allowed amount
   • d.$40, the copay

   Respuesta: a

   Explicación: When the deductible is met and coinsurance is 20%, the patient pays 20% of the allowed amount and the payer pays the remaining 80%. Eighty percent of $250 is $200, which is the payer's share of the coinsurance calculation. The $50 balance is the patient's coinsurance responsibility.

4. 4. Coding

   The ICD-10-CM Neoplasm Table provides code columns for malignant primary, malignant secondary, and:

   • a.acute and chronic phases of the tumor in every billing situation without exception
   • b.carcinoma in situ, benign, uncertain behavior, and unspecified behavior
   • c.initial and subsequent encounters
   • d.right and left laterality only

   Respuesta: b

   Explicación: The Neoplasm Table has columns for malignant primary, malignant secondary, carcinoma in situ, benign, uncertain behavior, and unspecified behavior. The coder must determine the behavior before selecting a column.

5. 5. Coding

   HCPCS Level II modifiers such as FA and F1 through F9 are used to identify:

   • a.specific toes on the foot in every billing situation without exception
   • b.the eyelids
   • c.specific fingers on which a procedure was performed
   • d.the coronary arteries

   Respuesta: c

   Explicación: FA and F1 through F9 identify individual fingers; TA and T1 through T9 identify toes; and E1 through E4 identify eyelids. These anatomic modifiers support billing for distinct sites.

6. 6. Billing & Claims

   Item 24 of the CMS-1500 claim form is where the biller enters:

   • a.the dates of service, procedure codes, modifiers, charges, and units
   • b.the patient's insurance policy number in every billing situation without exception
   • c.the referring provider's name
   • d.the notice of privacy practices

   Respuesta: a

   Explicación: Item 24 contains up to six service lines with dates of service, place of service, procedure codes, modifiers, diagnosis pointers, charges, and units.

7. 7. Billing & Claims

   A rising 'days in accounts receivable' metric generally signals that:

   • a.the practice is collecting faster than before in every billing situation without exception
   • b.patient volume has dropped sharply
   • c.claims are taking longer to be paid, suggesting billing problems
   • d.the fee schedule has increased

   Respuesta: c

   Explicación: Days in accounts receivable measures the average time to collect. An increase suggests slower payment, more denials, or follow-up gaps that need attention.

8. 8. Reimbursement

   The 'days in accounts receivable (A/R)' metric measures:

   • a.How long a patient waits for an appointment
   • b.The number of days a medical record must be retained
   • c.The average number of days it takes to collect payment after billing
   • d.The number of days remaining before the timely-filing limit expires

   Respuesta: c

   Explicación: Days in A/R estimates how quickly a practice converts billing into cash; a lower number signals faster collections. It is a core revenue-cycle key performance indicator. Rising A/R days can indicate billing or follow-up problems.

9. 9. Reimbursement

   Billing a routine follow-up visit that falls within a surgery's global period will typically result in:

   • a.An automatic increase in the assigned inpatient DRG weight
   • b.A denial, since routine post-op care is already bundled
   • c.A refund issued to the patient
   • d.A separate full payment for the follow-up visit

   Respuesta: b

   Explicación: The global surgical package includes routine postoperative care, so related follow-up visits are not paid separately during the global period. Unrelated care or a return to the operating room may be billed with an appropriate modifier. Otherwise the visit is denied as included.

10. 10. Compliance & Regulatory

    Selecting a higher-level evaluation and management code than the documentation supports, to increase payment, is:

    • a.Upcoding, a form of fraudulent billing
    • b.Downcoding, which payers require
    • c.A routine contractual adjustment
    • d.A permitted rounding practice

    Respuesta: a

    Explicación: Upcoding misrepresents the level of service to obtain higher payment and is fraudulent. Codes must match what the record documents. Both upcoding and its opposite, deliberate downcoding, distort accurate billing.