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Exam Review

Key Facts: NHA CBCS Exam

125

Total Exam Items

NHA CBCS Test Plan (100 scored + 25 pretest)

3 hours

Exam Time

NHA CBCS Test Plan

390/500

Passing Score

NHA scaled scoring (200–500 scale)

$134

Exam Application Fee

NHA store CBCS exam application (checked 2026-10-23)

33%

Billing & Reimbursement Domain

NHA CBCS Test Plan (33 of 100 items)

100

Practice Questions Here

OpenExamPrep question bank

The CBCS test plan defines a 125-item exam (100 scored + 25 pretest) over 3 hours, with a scaled passing standard of 390/500 (200–500 scale). Items are distributed across 4 domains: Revenue Cycle and Regulatory Compliance (15 items, 15%), Insurance Eligibility and Other Payer Requirements (20 items, 20%), Coding and Coding Guidelines (32 items, 32%), and Billing and Reimbursement (33 items, 33%). No reference books are allowed: coding manuals are not needed or allowed for exams on or after September 24, 2024, because the coding information appears with each question. The current CBCS test plan is based on a job analysis completed in 2020.

Sample NHA CBCS Practice Questions

Try these sample questions to review concepts for the NHA CBCS exam. Each question includes a detailed explanation. Start the interactive quiz above for the full 100+ question experience with AI tutoring.

1Which sequence correctly orders the major phases of the revenue cycle in a physician practice?
A.Charge capture, registration, claim submission, payment posting, coding
B.Pre-registration, registration/eligibility, charge capture, coding, claim submission, payment posting, denial management
C.Claim submission, registration, coding, charge capture, denial management, payment posting
D.Coding, charge capture, registration, eligibility, claim submission, payment posting
Explanation: The revenue cycle is a chronological workflow that begins before the patient arrives (pre-registration and eligibility verification), continues through the encounter (registration, charge capture, coding), claim submission, and ends with payment posting and denial follow-up. Skipping or reordering steps (e.g., billing before coding) causes denials and delayed reimbursement.
2A billing specialist receives a phone call from a patient's adult sister asking for the date of the patient's last office visit. The patient has not signed any release authorizing disclosure to the sister. Which response is most consistent with HIPAA?
A.Confirm the date because family members are exempt from HIPAA
B.Decline to confirm or deny that the patient has been seen and refer the caller to the patient
C.Provide the visit date but withhold the diagnosis
D.Mail a copy of the visit summary to the sister's address listed in the chart
Explanation: HIPAA's Privacy Rule prohibits disclosure of protected health information (PHI) to anyone not authorized by the patient. Even confirming that the patient was seen is a disclosure of PHI. The correct action is to neither confirm nor deny the relationship and to refer the caller back to the patient.
3Which federal law made it illegal to knowingly submit fraudulent claims to federal health-care programs and authorizes treble damages plus per-claim civil penalties?
A.Stark Law
B.False Claims Act
C.Anti-Kickback Statute
D.HITECH Act
Explanation: The False Claims Act (31 U.S.C. §§ 3729–3733) imposes liability on persons who knowingly submit, or cause to be submitted, false or fraudulent claims to the federal government. Penalties include treble (triple) damages and per-claim civil monetary penalties. Whistleblower (qui tam) provisions allow private individuals to file suits on behalf of the government.
4Which of the following constitutes protected health information (PHI) under HIPAA?
A.A de-identified data set with all 18 HIPAA identifiers removed
B.A patient's email address combined with their date of service
C.Aggregate population health statistics published by CDC
D.A coding manual purchased from AMA
Explanation: PHI is any individually identifiable health information held or transmitted by a covered entity. Email addresses are one of the 18 HIPAA identifiers; combined with health data such as a date of service they form PHI. Properly de-identified data, aggregate public-health statistics, and reference texts are not PHI.
5Which federal contractor is specifically tasked with identifying and recovering improper Medicare fee-for-service payments through post-payment review?
A.Medicare Administrative Contractor (MAC)
B.Recovery Audit Contractor (RAC)
C.Office of Civil Rights (OCR)
D.Comprehensive Error Rate Testing (CERT) contractor
Explanation: Recovery Audit Contractors (RACs) review Medicare claims on a post-payment basis to identify and recover overpayments and to identify underpayments. They are paid on a contingency-fee basis from the funds they recover. MACs process and pay claims; CERT measures the national paid-claims error rate; OCR enforces HIPAA.
6Under the HITECH Act's Breach Notification Rule, when must a covered entity notify the Secretary of HHS of a breach affecting 500 or more individuals?
A.Within 24 hours of discovery
B.Without unreasonable delay and in no case later than 60 calendar days from discovery
C.Within 90 days of the end of the calendar year
D.Only if the breach involves financial information
Explanation: For a breach involving 500 or more individuals, the Breach Notification Rule requires notice to the HHS Secretary at the same time as the notices to affected individuals: without unreasonable delay and no later than 60 calendar days after discovery. Prominent media must also be notified when more than 500 residents of a state or jurisdiction are affected. Breaches affecting fewer than 500 individuals are reported to HHS in an annual log within 60 days of the end of the calendar year.
7Which document signed by a Medicare patient before a service is rendered shifts financial responsibility to the patient when the service is likely to be denied as not medically necessary?
A.Coordination of Benefits (COB) statement
B.Advance Beneficiary Notice of Noncoverage (ABN)
C.Notice of Privacy Practices (NPP)
D.Assignment of Benefits (AOB)
Explanation: An Advance Beneficiary Notice of Noncoverage (ABN, Form CMS-R-131) is given to a Medicare fee-for-service beneficiary before a service Medicare may not cover. It informs the patient of the estimated cost and shifts financial liability to the patient if Medicare denies the claim. Without a required ABN, the provider cannot collect from the patient for a service Medicare denies as not reasonable and necessary.
8A medical biller notices a colleague consistently adds higher-level E/M codes than supported by documentation to maximize reimbursement. Which compliance term describes this behavior?
A.Unbundling
B.Upcoding
C.Downcoding
D.Modifier overuse
Explanation: Upcoding is the fraudulent practice of reporting a higher-paying code than the one supported by documentation. It violates the False Claims Act and CMS billing rules. Unbundling separates components that should be billed under a single comprehensive code; downcoding is the reverse of upcoding; modifier misuse is a separate concept.
9Which of the following best describes the Office of Inspector General's (OIG) primary role in medical billing oversight?
A.Setting CPT coding guidelines
B.Investigating fraud, waste, and abuse in HHS programs and publishing compliance guidance and the LEIE
C.Adjudicating denied Medicare claims on appeal
D.Maintaining the ICD-10-CM tabular list
Explanation: The OIG within HHS investigates fraud, waste, and abuse in federal health programs, publishes annual Work Plans, issues compliance program guidance, and maintains the List of Excluded Individuals/Entities (LEIE). CPT is maintained by the AMA, ICD-10-CM by NCHS/CMS, and Medicare appeals are handled by MACs/QICs.
10What is the principal difference between the HIPAA Privacy Rule and the HIPAA Security Rule?
A.The Privacy Rule applies only to paper records; the Security Rule applies only to electronic records
B.The Privacy Rule governs the use and disclosure of all PHI; the Security Rule sets administrative, physical, and technical safeguards specifically for electronic PHI
C.The Privacy Rule is enforced by OCR while the Security Rule is enforced by CMS
D.The Privacy Rule replaces state privacy laws; the Security Rule does not
Explanation: The Privacy Rule applies to PHI in any form (oral, paper, electronic) and regulates how it may be used and disclosed. The Security Rule sets specific administrative, physical, and technical safeguards for electronic PHI (ePHI). Both are enforced by HHS OCR, and HIPAA is a federal floor that does not preempt more stringent state privacy laws.

About the NHA CBCS Exam

The NHA CBCS exam is an NCCA-accredited, entry-level certification for medical billing and coding specialists. It validates competence across the full revenue cycle: regulatory compliance and HIPAA, insurance eligibility and payer rules, ICD-10-CM/CPT/HCPCS coding with proper modifier and sequencing logic, and billing/reimbursement workflows including the CMS-1500 and UB-04, EDI transactions, NCCI edits, denial management, and the Medicare appeals process. CBCS-certified specialists work in physician offices, outpatient clinics, billing companies, and hospital business offices.

Exam sponsor: NHA / PSI Testing Centers / Live Remote Proctoring. The requirements and fees below concern the certification or admission exam, separate from our free practice resources.

Assessment

100 scored items + 25 pretest items, all multiple-choice

Time Limit

3 hours

Passing Score

Scaled score 390/500

Exam / Certification Fees

$134 exam application (NHA store, checked 2026-10-23)

Exam sponsor website

Fees, eligibility, and exam policies can change. Confirm them with the exam sponsor before applying or paying.

Our practice resources: topics covered

We aim to reflect publicly available exam outlines and topic information in our study resources. Coverage, format, and difficulty may differ from the actual exam, and we cannot guarantee that every detail is accurate or current. Confirm exam requirements, fees, and policies with the official exam sponsor.

15 items (15%)

The Revenue Cycle and Regulatory Compliance

Phases of the revenue cycle; HIPAA Privacy, Security, and Breach Notification rules; PHI definitions and 18 identifiers; permitted disclosures and authorizations; fraud and abuse statutes (False Claims Act, Stark Law, Anti-Kickback Statute); auditing programs (RAC, ZPIC, CERT); Office of Inspector General role; OIG seven-element compliance plan; consent types (informed, implied, general); HITECH Act.

20 items (20%)

Insurance Eligibility and Other Payer Requirements

Insurance card data and required documentation; eligibility/benefits verification (270/271); commercial plans (HMO, PPO, EPO, indemnity); government plans (Medicare Parts A/B/C/D, Medicaid, Medigap, TRICARE); workers' compensation, auto, and homeowner's coverage; coordination of benefits and birthday rule; Medicare Secondary Payer; Advance Beneficiary Notice (ABN); referrals and prior authorization; predetermination; out-of-network rules; self-pay and financial-hardship policies.

32 items (32%)

Coding and Coding Guidelines

Anatomy and medical terminology; ICD-10-CM conventions, sequencing, and outpatient guidelines (annual Oct 1 update); ICD-10-CM vs ICD-10-PCS; CPT manual organization, sections (E/M 99202–99499, anesthesia, surgery, radiology, pathology, medicine), and 2021 office/outpatient E/M leveling; HCPCS Level II for DME, drugs, and Medicare G-codes; modifier use (-25, -59, -50, -76, -78, -79, -91, -RT/-LT, -GA/-GZ/-GY/-GX); place-of-service codes; telehealth POS 02/10 and modifier -95; physician queries; medical necessity.

33 items (33%)

Billing and Reimbursement

CMS-1500 fields (Block 21 diagnosis, 24A date, 24E pointer, 24F charge, 24G units, 24J rendering NPI, 33 billing) and UB-04/CMS-1450 form locators; NPI structure and use; HIPAA EDI 837P/I, 835 ERA, 270/271 eligibility, 999 functional acknowledgement, 277CA claim acknowledgement; NCCI Procedure-to-Procedure edits and Medically Unlikely Edits; LCD vs NCD coverage policies; payer-specific guidelines and timely filing; clean claims; EOB/ERA reading and payment posting; CARC/RARC denial codes; reconsideration and appeals (Medicare 5-level: redetermination, QIC, ALJ, Council, Federal court); aging reports; credit balances and the federal 60-day overpayment rule; resubmission with frequency code 7.

Preparing for the NHA CBCS Exam

What You Need to Know

  • Passing score: Scaled score 390/500
  • Assessment: 100 scored items + 25 pretest items, all multiple-choice
  • Time limit: 3 hours
  • Exam / certification fees: $134 exam application (NHA store, checked 2026-10-23) Official sources

Using Our Practice Resources

  • Work through all 100 available questions
  • Review every answer and explanation
  • Track weak areas and revisit them
  • Use our AI tutor for tough concepts

NHA CBCS: Suggested Study Strategy

1Master coding sequencing: list the underlying etiology before manifestations (ICD-10-CM 'code first' notes), report the most resource-intensive procedure first in CPT, and place add-on codes immediately after their primary codes.
2Memorize the high-yield modifiers: -25 (significant separate E/M with a procedure), -59 (distinct procedural service), -50 (bilateral), -76 (repeat by same provider), -78/-79 (return to OR within global period), -91 (repeat lab), -RT/-LT, and Medicare GA/GZ/GY/GX. Modifier questions appear throughout the coding domain.
3Distinguish HIPAA Privacy, Security, and Breach Notification rules. Privacy governs all PHI; Security adds administrative, physical, and technical safeguards specifically for ePHI; Breach Notification requires notice to individuals without unreasonable delay and no later than 60 calendar days after discovery; a breach of 500 or more individuals also goes to HHS at the same time (and to the media when more than 500 residents of one state are affected), while smaller breaches go on an annual log to HHS.
4Learn the CMS-1500 block-by-block: Block 21 (diagnoses), 24A (DOS), 24E (pointer), 24F (charge), 24G (units), 24J (rendering NPI), 33 (billing provider). Block knowledge overlaps with the EDI 837P transaction set.
5Practice EOB/ERA math (billed − allowed = contractual; deductible + coinsurance + copay = patient owes) and denial workflow (read CARC/RARC → verify cause → correct, appeal, or write off). Know the Medicare 5-level appeal sequence: redetermination → QIC reconsideration → ALJ → Council → Federal court.

Frequently Asked Questions

How many questions are on the NHA CBCS exam?

The CBCS exam has 125 total items: 100 scored multiple-choice questions plus 25 unscored pretest items, delivered over a 3-hour testing window. Pretest items are not identified during the exam, so answer every question carefully.

What score do I need to pass the NHA CBCS exam?

NHA uses scaled scoring on a 200–500 scale, with 390 as the passing standard for handbook-covered exams including CBCS. Scaled scoring corrects for minor difficulty differences between exam versions.

How much does the NHA CBCS exam cost?

The CBCS exam application costs $134 in the NHA store (checked October 23, 2026). Some schools and employers prepay the exam, and each retake costs the full exam price.

What are the four CBCS exam domains and their weights?

The 100 scored items are distributed as: The Revenue Cycle and Regulatory Compliance (15 items, 15%), Insurance Eligibility and Other Payer Requirements (20 items, 20%), Coding and Coding Guidelines (32 items, 32%), and Billing and Reimbursement (33 items, 33%). Coding and billing together account for 65% of the exam.

Is the CBCS exam open or closed book?

Closed book. No reference books are allowed, and NHA states that coding manuals are not needed or allowed for CBCS exams on or after September 24, 2024. The coding information needed for each question appears with the question.

Can I take the CBCS exam remotely?

Yes. NHA offers Live Remote Proctoring (LRP) so you can take the CBCS from home using a computer with webcam, microphone, and stable internet. You can also test at a PSI testing center or, if eligible, at your training school.

What happens if I fail the CBCS exam?

After a failed attempt, NHA requires at least 30 days before retaking. You get three attempts with at least 30 days between them; after a third failed attempt you must wait 1 year before each further attempt. Each retake requires re-registering and paying the full exam price.

How is CBCS different from AAPC CPC or AHIMA CCA/CCS?

CBCS is NHA's entry-level billing-and-coding credential, accredited by NCCA, and weighted heavily toward billing workflow (33%) and payer/claims operations. CPC (AAPC) is more deeply focused on physician CPT coding; CCA (AHIMA) is broader entry-level coding; CCS (AHIMA) targets hospital inpatient and outpatient coders. Many billing-and-coding career starters use CBCS as a fast on-ramp.