NHA CBCS case studies
NHA CBCS · Put your knowledge to work in context.
The Certified Billing and Coding Specialist (CBCS) is one of the eight certifications offered by the National Healthcareer Association (NHA), an allied health certification agency that states it has awarded over 1 million nationally recognized certifications and describes its certifications as NCCA-accredited and recognized by employers nationwide. NHA summarizes the CBCS role in a single line: specialists "support healthcare organizations by managing claims, invoices and payments." That description frames the credential as a revenue-cycle role rather than a clinical one, which is why candidates typically come from medical billing and coding programs, medical administrative assistant roles, or front-office and reimbursement positions that want a formal, verifiable credential. The NHA CBCS case studies are 5 cases and about 2,615 words.
1Same-Day E/M and Minor Procedure Denied as Bundled
On March 12, a 58-year-old patient with a Medicare Advantage plan was seen in a primary care office. The provider billed 99214-25 for management of hypertension and type 2 diabetes and 11402 for same-day excision of a benign arm lesion.
566 words, about 3 min2Medicare Secondary Payer Denial on a Working-Aged Patient
On April 8, a 67-year-old patient was seen for a new patient office visit. The patient is still working full time for an employer with 30 employees and is enrolled in the employer's group health plan.
531 words, about 3 min3Underpayment From Incorrect Multiple-Procedure Reduction
A practice has a contract with a commercial payer that sets the allowed amount for CPT 11403 at 800 and CPT 11402 at 600. The contract states that when a second surgical procedure is performed in the same operative session, the secondary procedure is reimbursed at 75% of its allowed amount.
518 words, about 3 min4Patient Deposit Misposted and Credit Balance Refund
On June 3, a patient had a diagnostic colonoscopy and paid a 500 deposit at check-in. The payer allowed 800, applied 20% coinsurance, and paid 640.
462 words, about 2 min5Timely Filing Denial After Clearinghouse Rejection
On January 10, a provider saw a 45-year-old patient with commercial insurance. The claim was submitted electronically to the payer on March 30, which was day 79 of the payer's 90-day timely filing limit.
538 words, about 3 min