Certified Billing and Coding Specialist (NHA) Exam Flashcards

100 scored questions.

180 minutes (3 hours).

A scaled score of 390 or higher.

$129 USD.

Roughly 1.8 minutes each — 180 minutes divided across 100 scored questions.

It is the standard paper claim form used by non-institutional providers (physicians and suppliers) to bill payers for professional services.

CPT codes report procedures and services performed; ICD-10-CM codes report diagnoses (the reason for the service).

Reporting products, supplies, and services not covered by CPT — such as durable medical equipment, drugs, and ambulance services.

A statement from the payer to the patient/provider explaining how a claim was processed — what was paid, denied, or applied to patient responsibility.

Protected Health Information — individually identifiable health information that must be safeguarded under the Privacy and Security Rules.

Two-character add-ons that provide additional detail about a procedure — e.g., that it was altered, bilateral, or distinct — without changing the code's core meaning.

Fraud is intentional deception for unlawful gain (e.g., billing for services not rendered); abuse is improper practices that cause unnecessary cost without proven intent.

A claim with no errors or missing information that can be processed without additional documentation — clean claims are paid faster and reduce denials.

The service must be reasonable and necessary to diagnose or treat the patient's condition; the diagnosis (ICD-10-CM) must support the procedure (CPT/HCPCS) or the claim may be denied.