Certified Billing and Coding Specialist (CBCS) Review & Study Guide

Essential Test Prep Tips to Help You Pass the CBCS Exam the First Time

If you’re a Medical Office Administrator (MOA), you can advance your career with certification. Some benefits can include higher wages and job stability, not to mention a bright career outlook!

(Click here to learn how to become a Medical Office Administrator).

This article will focus on the CBCS certification, which stands for Certified Billing and Coding Specialist. The CBCS exam is administered by the National Healthcareer Association (NHA). Since 1989, this organization has awarded more than 750,000 certifications to healthcare students and professionals.

If you’re thinking of becoming a CBCS, we created this guide to help you succeed while preparing for the certification exam.

What Is the CBCS Exam?

The CBCS exam is a professional certification that qualifies you to become a Certified Billing and Coding Specialist.

This timed exam highlights your competency in the field of data management. It contains a number of questions that demonstrate your knowledge and skills within coding and billing administration.

A Billing & Coding Specialist performs several functions in a medical office, including the following duties and responsibilities:

• Gathering and reviewing essential patient information
• Verifying required documentation before patient information is released
• Preventing fraud and abuse through billing audits
• Support coding and billing process
• Assigning billing codes for diagnoses and procedures
• Submitting claims for reimbursement
• Coaching healthcare providers to achieve optimal reimbursement

How to Apply for the CBCS Exam

Applicants who meet one of the NHA’s eligibility categories must complete the following steps to apply for the CBCS Exam:

Step 1: Determine your eligibility

Step 2: Set up your NHA account

Step 3: Apply and schedule your exam

Step 4: Prepare for your exam

You can learn more about each of these steps here.

CBCS Exam Requirements

What Are the Requirements to Take the CBCS Exam?

The NHA requirements for the CBCS exam are as follows:

• Successfully complete a program that includes medical billing and coding training within the last 5 years.
  • Note: This training program should be offered by an accredited or state-recognized institution or provider.
• Hold a high school diploma or GED/high school equivalent.

What Is on the CBCS Exam?

CBCS certification doesn’t have to be a taxing experience. The NHA offers a free, detailed test plan to help you study. They also provide additional study materials, but those may require a fee.

Here are the various subjects and sub-topics that are covered by the CBCS exam:

1. Regulatory Compliance (19 Items)
   • Identify appropriate documentation required for release of patient information.
   • Audit billing against medical documentation to prevent fraud and abuse.
   • Identify major laws, regulations, and administrative agencies relevant to medical billing.

2. Claims Processing (28 Items)
   • Apply procedures for transmitting claims to third-party payers.
   • Apply knowledge of the CMS-1500 form to accurately complete the appropriate fields.

3. Front-end Duties (10 items)
   • Ensure accurate collection of appropriate patient demographic and insurance information
   • Verify insurance eligibility to determine benefits.
   • Compare and contrast government and private insurance.
   • Process appropriate patient authorization and referral forms.
   • Prior to the visit, determine appropriate balances due.

4. Payment Adjudication (23 items)
   • Analyze aging report.
   • Post payment accurately
   • Interpret remittance advice to determine financial responsibility of patient and insurance company.
   • Determine reason for insurance company denial.

5. Apply Knowledge of Coding (20 items)
   • Apply specific coding guidelines and conventions for diagnoses and procedures.
   • Abstract the medical documentation by applying knowledge of medical terminology and anatomy and physiology.

How to Best Prepare for the CBCS Exam

To help you prepare for the CBCS exam, let’s begin by answering some of the most frequently asked questions about the exam itself.

Where can you take the CBCS exam?

CBCS testing will take place at your school or at a PSI Testing Center near you. You will need to present valid identification and complete the test in one session.

How much time do you have to complete the CBCS exam?

You’ll have two hours to complete the CBCS exam.

How many questions are on the CBCS exam?

The CBCS is a computer-based exam and it consists of 100 questions and 20 pretest questions.

What is the passing score for the CBCS exam?

Scaled scores for NHA exams range from 200 to 500 and require that a candidate meet a scaled passing score of 390 or higher in order to pass.

How much does it cost to take the CBCS exam?

The CBCS exam costs about $117. You can learn more on the NHA website.

What else can you do to prepare for the CBCS exam?

As you prepare for the exam, you may want to explore additional NHA study materials:

• Online Study Package: $69
• Online Study Guide: $48
• Online Practice Test: $39
• Printed Study Package: $69
• Printed Study Guide: $48

When do you receive your CBCS exam results?

The NHA will officially post your CBCS exam results to your account page within two days of taking the test, and your printed certificate will arrive within two weeks. If you take the written exam, results will be posted within two weeks on your personal account page.

CBCS Test Prep

CBCS Sample Questions

To help you gauge some of the topics on the exam, we compiled a few sample questions taken directly from Quizlet’s online flashcards.

1. Q: What are medical ethics?
   • A: Standards of conduct based on moral principle. They are generally accepted as a guide for behavior towards patients, doctors, co-workers, the government, and insurance companies.

2. Q: What does it mean to act within ethical behavior boundaries?
   • A: It means to carry out one’s responsibilities with integrity, dignity, respect, honesty, competence, fairness, and trust.

3. Q: What is the Health Insurance Portability & Accountability Act (HIPPA)?
   • A: Enacted in 1996, HIPPA was created by the Health Care Fraud & Abuse Control Program-enacted to check for fraud and abuse in Medicare/Medicaid Programs and private payers.

4. Q: What are the two provisions of HIPPA?
   • A: Title I: Insurance Reform and Title II: Administrative Simplification.

5. Q: Who audits claims?
   • A: State and federal agencies as well as private insurance companies.

6. Q: What are common forms of fraud?
   • A: Some forms include billing for services not furnished, unbundling, and misrepresenting diagnosis to justify payment.

7. Q: What is employer liability?
   • A: Physicians are legally responsible for their own conduct and any actions of their employees (designee) performed within the context of their employment. It also means that employees can be sued and brought to trial.

8. Q: What is employee liability?
   • A: This is protection against loss of money caused by failure through error or unintentional omission on the part of the individual or service submitting the claim.

9. Q: What is a medical record and what is it comprised of?
   • A: It is documentation of the patient’s social and medical history, family history, physical exam findings, progress notes, radiology and lab results, consultation reports, and correspondence with the patient. It’s considered the foremost tool of clinical care and communication.

10. Q: What are some reasons for documentation?
    • A: Every patient seen by a doctor must have comprehensive legible documentation about their illness, treatment, and plans for the following reasons:
      • Avoidance of denied or delayed payment by insurance companies investigating the medical necessity of services
      • Enforcement of medical record-keeping rules by insurance companies requiring accurate documentation that supports procedure and diagnosis codes
      • Subpoena of medical records by state investigators or the court for review
      • Defense of professional liability claim

Retaking the CBCS (NHA) Certification Exam

If you didn’t pass your exam, try not to feel discouraged—those who don’t pass their first or second attempt can re-apply after 30 days.

How many times can you fail the CBCS Exam?

If you fail your third attempt, you must wait 12 months before you can retake the CBCS exam. So, take your time and ensure you have prepared yourself. When test day arrives, you can relax knowing you’ve given it your all!

Learn more about this process here.

CBCS Test-Prep Strategies

Here are a few test-prep tips to help you while retaking the exam. Remember: As long as you try, you’ll do great!

• First and foremost, lessen your stress levels. Study a little every day and take breaks as needed. Get a good night’s rest. Practice meditation, go on walks, and take deep breaths.
• Don’t be shy about asking for help. If you’re confused about your previous test scores or the subject matter in general, reach out to a teacher, an aide, or a classmate. They may offer a new perspective or strategy that can help you succeed.
• Try study materials from the NHA or other resources. There’s plenty of information at your disposal on the internet. If you’re not comfortable paying for NHA study materials, you can also find a free study guide/content online on the NHA’s website.
• Dress comfortably on the day of the retake. You don’t want to feel uncomfortable or become distracted by your clothes.
• Arrive early to account for any issues. Make sure you set aside plenty of time the morning of your exam. This can help curb extra stress or allow for unforeseen events.
• Follow your own pace. Wise people once said, “Comparison is the thief of joy.” Don’t pay attention to anyone else. Watch the clock to ensure you complete the exam in the allotted time but, otherwise, tune out your surrounding environment. Review each question and use your best judgment; try not to second guess yourself.

CBCS Recertification

The NHA has outlined the following steps for  CBCS renewal. You must renew your certification on or before your expiration date; there is no penalty for renewing early.

Steps for CBCS Recertification

1. Log in to your nhanow.com account.
2. Select “Renew Certifications” on the left menu.
3. Select “Complete More CE” to view the library.
4. Complete 10 continuing education credits.
5. Pay your recertification fee. Renewing your certification costs $169 every two years, which is about $7 a month.

Note: Certificate holders who passed the CBCS exam prior to October 1, 2015 must complete a minimum of 5 of their 10 required Continuing Education (CE) credits in an ICD-10 specific related course(s). Read more here.

The Benefits of an MOA Diploma

If you’re not ready to launch your career as a Certified Billing and Coding Specialist, you may want to consider pursing a diploma in Medical Office Administration.

Although it may not qualify you for the CBCS Certification exam, MOA training can help you gauge your interest and passion for the field before pursuing additional training or a degree.

The responsibilities of a Medical Office Administrator may even mirror the job duties of a CBCS specialist. These can include but are not limited to the following tasks:

• Reviewing patients’ records for timeliness and accuracy
• Organizing and managing data for clinical databases and registries
• Tracking patient outcomes
• Using software to administer insurance reimbursement and data analysis
• Recording data for collection, storage, analysis, and reporting
• Maintain patient record confidentiality

Furthermore, an MOA diploma program could also lead to field experience, which can equip you with the knowledge, skills, and prior work history to help you seek employment upon receiving your CBCS certification.

Develop Your Career in Healthcare

Our goal for this article was to provide you with practical tips on how to pass the CBCS (NHA) Certification Exam. We hope it gives you the knowledge and confidence to take that next step in your career.

Based on their training and experience, Billing and Coding Specialists can pursue a variety of employment opportunities. The skills learned through NHA certification are essential to hospitals, physician offices, surgery centers, nursing homes, dental offices, and more.

CBCS certification can open the door to a rewarding career path. Don’t wait another moment to change your life.

Best of luck!