NHA Medical Billing & Coding (CBCS) Practice Test

Câu hỏi luyện tập mẫu

Một vài câu hỏi thực tế từ ngân hàng miễn phí này, kèm giải thích đầy đủ. Dùng công cụ luyện tập ở trên cho toàn bộ.

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

   Đáp án: a

   Giải thích: 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

   Đáp án: c

   Giải thích: 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

   Đáp án: a

   Giải thích: 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

   Đáp án: b

   Giải thích: 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

   Đáp án: c

   Giải thích: 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

   Đáp án: a

   Giải thích: 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

   Đáp án: c

   Giải thích: 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

   Đáp án: c

   Giải thích: 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

   Đáp án: b

   Giải thích: 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

    Đáp án: a

    Giải thích: 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.