NHA Billing and Coding Practice Test
Questions And Answers 2025
1. A billing and coding specialist discovers that one private payer has not reimbursed
the provider for any claims submitted in the past year. Clean claims have been
submitted to the payer and have been acknowledged. Which of the following entities
should the specialist contact to report the payer's failure to submit timely
reimbursement? - Correct Answer-a. State Insurance Commissioner's office
1. Which of the following is an example of a diagnostic category code? - Correct
Answer-a. I10
1. The star symbol in the CPT coding manual is used to indicate which of the following?
- Correct Answer-a. Telemedicine
1. Which of the following is an advantage of electronic claim submission? - Correct
Answer-a. Claims are expedited
1. When should a billing and coding specialist initiate the collection of the information
needed to process a patient's insurance claim form? - Correct Answer-a. When the
patient contacts the provider's office and schedules an appointment
1. A billing and coding specialist is reviewing modifier use with a new employee. Which
of the following scenarios warrants the use of a modifier? - Correct Answer-a. Splinting
of the fourth digit on the left foot
1. A billing and coding specialist is reviewing a provider's documentation for a patient
who underwent repair of multiple wounds to the face and trunk. The provider coded
repair of all wounds individually. The specialist should recognize that the provider
should have applied which of the following concepts to the documentation of the repair
for this patient's wounds? - Correct Answer-a. Wounds should be grouped by anatomic
site and coded in order of complexity
1. Which of the following terms describe the removal of the eye, adnexa, and bony
structure? - Correct Answer-a. Exenteration
1. A billing and coding specialist is reviewing delinquent claims and discovers that a
third-party payer paid a claim but applied it to the incorrect provider. The third-party
payer will reimburse the payment once the improperly paid funds are recouped. Which
of the following terms is used to describe this claim? - Correct Answer-a. Suspended
, 1. For which of the following reasons should a claim be resubmitted? - Correct Answer-
a. The claim requires an attachment to support medical necessity
1. A billing and coding specialist is preparing an account receivable aging report. The
specialist should expect the report to include which of the following? - Correct Answer-a.
Outstanding balances organized by date
1. Which of the following pieces of guarantor information is required when establishing a
patient's financial record? - Correct Answer-a. Phone number
1. Which of the following actions by a billing and coding specialist ensures a patient's
health information is protected? - Correct Answer-a. Using data encryption software on
office workstations
1. A billing and coding specialist is preparing an appeal letter in response to a denial by
a third-party payer for lack of medical necessity. Which of the following should the
specialist include with the letter to indicate medical necessity? - Correct Answer-a.
Medical record documentation
1. A child is brought into a facility by their mother. The child is cover under both parents'
insurance policies. The child's father was born on 10/1/1980 and their mother was born
on 10/2/1921. Which of the following statements is true regarding the primary policy
holder for the child? - Correct Answer-a. The father is the primary policy holder because
his birthday falls first in the calendar year
1. A billing and coding specialist is processing a claim for a patient who broke their arm
while repairing cars at their workplace. There is no nerve damage, the arm is placed in
a cast for 6 weeks, and the patient is cleared to return to work in 6 weeks. Which of the
following types of workers' compensation applies to this patient? - Correct Answer-a.
Temporary disability
1. Which of the following information is required on a patient account required? - Correct
Answer-a. Name and address of guarantor
1. A billing and coding specialist is reviewing a delinquent claim. Which of the following
actions should the specialist take first? - Correct Answer-a. Verify the age of the
account
1. A patient presents to a provider's office with difficulty speaking, facial drooping, and
an inability to close their left eye. They are diagnosed with Bell's palsy. A billing and
coding specialist should report which of the following ICD-10-CM codes? - Correct
Answer-a. G51.0
1. A patient has a breast biopsy with the placement of a clip. After the biopsy is
determined to be malignant, the patient elects for a mastectomy during the global period
Questions And Answers 2025
1. A billing and coding specialist discovers that one private payer has not reimbursed
the provider for any claims submitted in the past year. Clean claims have been
submitted to the payer and have been acknowledged. Which of the following entities
should the specialist contact to report the payer's failure to submit timely
reimbursement? - Correct Answer-a. State Insurance Commissioner's office
1. Which of the following is an example of a diagnostic category code? - Correct
Answer-a. I10
1. The star symbol in the CPT coding manual is used to indicate which of the following?
- Correct Answer-a. Telemedicine
1. Which of the following is an advantage of electronic claim submission? - Correct
Answer-a. Claims are expedited
1. When should a billing and coding specialist initiate the collection of the information
needed to process a patient's insurance claim form? - Correct Answer-a. When the
patient contacts the provider's office and schedules an appointment
1. A billing and coding specialist is reviewing modifier use with a new employee. Which
of the following scenarios warrants the use of a modifier? - Correct Answer-a. Splinting
of the fourth digit on the left foot
1. A billing and coding specialist is reviewing a provider's documentation for a patient
who underwent repair of multiple wounds to the face and trunk. The provider coded
repair of all wounds individually. The specialist should recognize that the provider
should have applied which of the following concepts to the documentation of the repair
for this patient's wounds? - Correct Answer-a. Wounds should be grouped by anatomic
site and coded in order of complexity
1. Which of the following terms describe the removal of the eye, adnexa, and bony
structure? - Correct Answer-a. Exenteration
1. A billing and coding specialist is reviewing delinquent claims and discovers that a
third-party payer paid a claim but applied it to the incorrect provider. The third-party
payer will reimburse the payment once the improperly paid funds are recouped. Which
of the following terms is used to describe this claim? - Correct Answer-a. Suspended
, 1. For which of the following reasons should a claim be resubmitted? - Correct Answer-
a. The claim requires an attachment to support medical necessity
1. A billing and coding specialist is preparing an account receivable aging report. The
specialist should expect the report to include which of the following? - Correct Answer-a.
Outstanding balances organized by date
1. Which of the following pieces of guarantor information is required when establishing a
patient's financial record? - Correct Answer-a. Phone number
1. Which of the following actions by a billing and coding specialist ensures a patient's
health information is protected? - Correct Answer-a. Using data encryption software on
office workstations
1. A billing and coding specialist is preparing an appeal letter in response to a denial by
a third-party payer for lack of medical necessity. Which of the following should the
specialist include with the letter to indicate medical necessity? - Correct Answer-a.
Medical record documentation
1. A child is brought into a facility by their mother. The child is cover under both parents'
insurance policies. The child's father was born on 10/1/1980 and their mother was born
on 10/2/1921. Which of the following statements is true regarding the primary policy
holder for the child? - Correct Answer-a. The father is the primary policy holder because
his birthday falls first in the calendar year
1. A billing and coding specialist is processing a claim for a patient who broke their arm
while repairing cars at their workplace. There is no nerve damage, the arm is placed in
a cast for 6 weeks, and the patient is cleared to return to work in 6 weeks. Which of the
following types of workers' compensation applies to this patient? - Correct Answer-a.
Temporary disability
1. Which of the following information is required on a patient account required? - Correct
Answer-a. Name and address of guarantor
1. A billing and coding specialist is reviewing a delinquent claim. Which of the following
actions should the specialist take first? - Correct Answer-a. Verify the age of the
account
1. A patient presents to a provider's office with difficulty speaking, facial drooping, and
an inability to close their left eye. They are diagnosed with Bell's palsy. A billing and
coding specialist should report which of the following ICD-10-CM codes? - Correct
Answer-a. G51.0
1. A patient has a breast biopsy with the placement of a clip. After the biopsy is
determined to be malignant, the patient elects for a mastectomy during the global period
