CBCS study guide
CBCS · Work through your exam, one topic at a time.
The Certified Billing and Coding Specialist (CBCS) is one of the eight certifications offered by the National Healthcareer Association (NHA). NHA describes its certifications as NCCA-accredited and recognized by employers nationwide, and it lists the CBCS alongside credentials such as the CCMA, CPhT, CPT and CMAA. The CBCS study guide has 5 sections and about 1,779 words.
01Insurance Eligibility and Prior Authorization
Verification confirms the plan is active on the date of service, that the patient is covered for the service type, and the financial terms that drive the patient estimate: deductible, copay, coinsurance, and out-of-pocket maximum. Confirm identity, member ID, group number, plan type (HMO, PPO, POS), network status of the rendering and facility providers, and any waiting periods or exclusions.
381 words, about 2 min02Coding: Diagnosis and Procedure
ICD-10-CM carries diagnoses; CPT describes professional services and procedures; HCPCS Level II covers drugs, supplies, and G codes. ICD-10-CM conventions matter: start in the Alphabetic Index, then verify in the Tabular List.
363 words, about 2 min03Billing, Claims Submission, and Reimbursement
Use the CMS-1500 (837P) for professional claims and the UB-04 (837I) for institutional claims. Critical fields include the insurance type, the insured's ID, the patient's relationship to the subscriber, diagnosis pointers on each service line, CPT or HCPCS with modifiers, charges, units, place of service, and the billing provider NPI.
328 words, about 2 min04Accounts Receivable, Collections, and Revenue Cycle
Pre-registration, registration and eligibility, charge capture, coding, claim submission, remittance posting, denial management, AR follow-up, and collections. Every handoff leaks revenue; most denials are created before the claim is ever sent.
350 words, about 2 min05Compliance, Privacy, and Regulatory Requirements
HIPAA has three parts to know. The Privacy Rule governs uses and disclosures, requires minimum necessary, permits treatment, payment, and operations without authorization, and grants patients rights to access, amend, and receive an accounting of disclosures.
357 words, about 2 min