National Center for Competency Testing.(NCCT) Insurance & Coding
Practice Test Actual Exam 2026 || Most Recent Exam 2026|2027
Actual Complete Real Exam Questions And Correct Answers (Verified
Answers) Already Graded A+ | Guaranteed Success!! Newest Exam |
Just Released!!
A patient is covered by two health insurance policies. Which rule may
be used to determine the primary insurance when both policies cover a
dependent child? -ANSWER- The Birthday Rule. Under the standard
birthday rule for dependent children, the plan of the parent whose
birthday falls earlier in the calendar year is generally primary,
regardless of which parent is older. Exceptions may apply under
custody arrangements and specific plan provisions.
A medical billing specialist receives a claim for a service that requires
prior authorization. What should the specialist verify before submitting
the claim? -ANSWER- Whether the required authorization was obtained
and whether it covers the service provided. Prior authorization
confirms that a payer has reviewed a proposed service under its
authorization process, but it does not necessarily guarantee payment.
A patient presents an insurance card, but the policy may have expired.
What action should the medical office take? -ANSWER- Verify the
patient's current eligibility and benefits with the payer. Eligibility
verification helps establish whether coverage is active on the date of
service and identifies applicable copayments, deductibles, and coverage
limitations.
, A claim contains a diagnosis code that does not support the medical
necessity requirements of the billed procedure. What should the coding
specialist do? -ANSWER- Review the clinical documentation, verify the
diagnosis and procedure codes, and correct any supported coding
errors. Medical necessity must be supported by the medical record and
applicable payer policy; a coder must not change a diagnosis merely to
obtain reimbursement.
A provider performs a procedure that is more extensive than the basic
service described by the procedure code. What should the coding
specialist review before selecting a modifier? -ANSWER- The procedure
documentation and the official coding guidelines for the applicable
modifier. A modifier may communicate a qualifying circumstance
affecting the service, but it must be supported by documentation and
permitted by the relevant coding rules.
A medical office receives a claim rejection because the patient's date of
birth does not match the insurer's records. What is the appropriate
response? -ANSWER- Verify the patient's demographic information,
correct the discrepancy, and resubmit the claim according to payer
instructions. Accurate patient identification is necessary for claim
processing and helps prevent repeated rejections.
A patient has not met the annual deductible for a covered service
subject to that deductible. Who generally pays the applicable
deductible amount? -ANSWER- The patient pays the amount assigned
to the deductible under the insurance plan. The deductible is the
amount the insured generally must pay for eligible services before the
Practice Test Actual Exam 2026 || Most Recent Exam 2026|2027
Actual Complete Real Exam Questions And Correct Answers (Verified
Answers) Already Graded A+ | Guaranteed Success!! Newest Exam |
Just Released!!
A patient is covered by two health insurance policies. Which rule may
be used to determine the primary insurance when both policies cover a
dependent child? -ANSWER- The Birthday Rule. Under the standard
birthday rule for dependent children, the plan of the parent whose
birthday falls earlier in the calendar year is generally primary,
regardless of which parent is older. Exceptions may apply under
custody arrangements and specific plan provisions.
A medical billing specialist receives a claim for a service that requires
prior authorization. What should the specialist verify before submitting
the claim? -ANSWER- Whether the required authorization was obtained
and whether it covers the service provided. Prior authorization
confirms that a payer has reviewed a proposed service under its
authorization process, but it does not necessarily guarantee payment.
A patient presents an insurance card, but the policy may have expired.
What action should the medical office take? -ANSWER- Verify the
patient's current eligibility and benefits with the payer. Eligibility
verification helps establish whether coverage is active on the date of
service and identifies applicable copayments, deductibles, and coverage
limitations.
, A claim contains a diagnosis code that does not support the medical
necessity requirements of the billed procedure. What should the coding
specialist do? -ANSWER- Review the clinical documentation, verify the
diagnosis and procedure codes, and correct any supported coding
errors. Medical necessity must be supported by the medical record and
applicable payer policy; a coder must not change a diagnosis merely to
obtain reimbursement.
A provider performs a procedure that is more extensive than the basic
service described by the procedure code. What should the coding
specialist review before selecting a modifier? -ANSWER- The procedure
documentation and the official coding guidelines for the applicable
modifier. A modifier may communicate a qualifying circumstance
affecting the service, but it must be supported by documentation and
permitted by the relevant coding rules.
A medical office receives a claim rejection because the patient's date of
birth does not match the insurer's records. What is the appropriate
response? -ANSWER- Verify the patient's demographic information,
correct the discrepancy, and resubmit the claim according to payer
instructions. Accurate patient identification is necessary for claim
processing and helps prevent repeated rejections.
A patient has not met the annual deductible for a covered service
subject to that deductible. Who generally pays the applicable
deductible amount? -ANSWER- The patient pays the amount assigned
to the deductible under the insurance plan. The deductible is the
amount the insured generally must pay for eligible services before the
