NHA CBCS Practice Test

Answer choices

1. A. Code from the operative report and relevant documentation; do not query for details that do not affect code assignment.
2. B. Hold coding until the provider documents additional postoperative tolerance findings, even though the operative report already contains the elements needed for code assignment.
3. C. Change the procedure code based on the nursing statement.
4. D. Omit the procedure because the nursing note lacks a full postoperative assessment.

Wrong-answer review

• B. Hold coding until the provider documents additional postoperative tolerance findings, even though the operative report already contains the elements needed for code assignment.: This goes beyond or around the provider documentation instead of reporting only the facts the record supports.
• C. Change the procedure code based on the nursing statement.: The nursing note does not contradict the documented procedure and does not provide a basis to change the code.
• D. Omit the procedure because the nursing note lacks a full postoperative assessment.: The code is supported by the operative documentation; unrelated missing detail does not erase the performed service.

Answer choices

1. A. Add denial-management staff to rework the rejected claims faster while leaving the upstream registration or claim-validation defect unchanged.
2. B. Submit claims faster so the payer sees the error sooner.
3. C. Ask coders to change diagnosis codes when member-ID edits occur.
4. D. Strengthen insurance verification at registration and add a pre-transmission validation control for member identifiers.

Answer choices

1. A. Submit a revised claim with the correct CPT code and detailed documentation of the procedure’s justification.
2. B. Request a secondary review of the claim by the payer’s medical review department.
3. C. File a formal appeal with the payer, citing the documented evidence of compliance.
4. D. Reverify the patient’s current insurance card and member information before correcting the documented coding defect that caused the denial.

Answer choices

1. A. ICD-10-CM
2. B. CPT
3. C. ICD-10-PCS
4. D. HCPCS

Answer choices

1. A. Confirm the current coverage status and coordination information with both payers before submitting the claim
2. B. Utilize the birthday rule to determine the primary payer’s coverage period
3. C. Immediately bill the primary plan, as it was the initial coverage
4. D. Submit first to the previously primary plan because it historically coordinated the account, then update coordination information only if that payer rejects for inactive coverage.

Answer choices

1. A. No PHI may be disclosed to a payer unless the patient signs a new authorization for every claim.
2. B. Send the full requested record set because the request came through an authenticated channel, rather than limiting the disclosure to the information needed for the stated purpose.
3. C. The office should change the clinical documentation to match the payer’s request before sending it.
4. D. The office may disclose PHI permitted for payment, limiting the disclosure to the information reasonably necessary for that payment purpose.

Answer choices

1. A. Review the claim details and the payer’s remittance explanation
2. B. Escalate the discrepancy to the payer’s contract department
3. C. Immediately post the adjustment to the patient’s account
4. D. Contact the surgeon’s office to discuss the adjustment

Answer choices

1. A. Immediately process the claim using the new insurance information
2. B. Verify patient and plan information and obtain missing required documentation before relying on coverage
3. C. Use the patient’s confirmation of the insurance-card details as the verification step and contact the payer only if the claim later rejects.
4. D. File a new claim with the outdated insurance information to avoid delays

Answer choices

1. A. Immediately suspend billing for all durable medical equipment to prevent further charges
2. B. Notify the payer of the identified pattern and request a review of the billing practices
3. C. Conduct a thorough investigation of the billing practices, documenting all findings and actions taken
4. D. Implement a system for regular audits of durable medical equipment billing to identify potential discrepancies

Answer choices

1. A. Assign modifier -59 to the treatment code to indicate non-physician services.
2. B. Ask the payer whether the treatment may be billed under a coverage exception before obtaining documentation that supports the treatment actually reported.
3. C. Reconcile the charges to the supported documentation and validate the required fields before transmission.
4. D. Submit the claim with the evaluation code and note the lack of treatment documentation.