NHA - MBC - Practice Test #2
Questions With Complete Solutions
/. Which of the following is used to communicate why a claim line item was denied or
paid differently than it was billed? - Answer-✅Claims adjustment reason codes
/.A billing and coding specialist is reviewing a claim edit report and identifies a rejection
for missing patient demographic information. Which of the following missing pieces of
patient demographic information would cause rejection from the clearinghouse? -
Answer-✅Date of birth
/.A billing and coding specialist is reviewing paperwork that indicates overpayment by
Medicare for six patients over the past year. Which of the following describes this
process? - Answer-✅Audit
/.Which of the following describes an insurance company that offers plans that pay
health care providers who render services to patients? - Answer-✅Third-party payer
/.Which of the following sections of the CPT manual lists the code for WBC with
differential, automated? - Answer-✅Pathology and Laboratory
/.A billing and coding specialist is reviewing provider notes to complete a claim. They
need clarification on whether the procedure performed was on the left side, right side, or
bilaterally. The specialist queries the provider and the provider confirms it was a
bilateral procedure. Which of the following modifiers should be billed? - Answer-✅-50
/.A provider orders a comprehensive metabolic panel for a 70-year-old patient who has
Medicare as their primary insurance. Which of the following is required to inform the
patient they may be responsible for payment? - Answer-✅Advance Beneficiary Notice
/.A billing and coding specialist is appealing a Medicare denial. Which of the following is
the first step in the appeals process? - Answer-✅Redetermination
/.A patient has a history of breast cancer that has metastasized to the liver and is
undergoing chemotherapy today for the liver cancer. Which of the following ICD-10-CM
codes should be sequenced first? - Answer-✅Z51.11
/.Which of the following are used to code provider and outpatient services? - Answer-
✅CPT codes
, /.A patient who is insulin-dependent is diagnosed with diabetic retinopathy. According to
ICD-10-CM coding guidelines, in which of the following orders should the codes be
reported in the claim form? - Answer-✅E11.319, Z79.4
/.Which of the following is a covered entity affected by HIPAA security rules? - Answer-
✅Health care clearinghouses
/.Which of the following actions by a billing and coding specialist is an example of fraud?
- Answer-✅Billing for services not provided to obtain higher reimbursement
/.Which of the following should be included on a claim form that is sent from a specialist
to a managed health care organization? - Answer-✅The referring provider's national
provider identifier (NPI)
/.Which of the following is a document used to analyze accounts receivable based on
dates of service? - Answer-✅Aging report
/.A billing and coding specialist is processing a claim for a new patient who came to the
office for a sore throat. The provider diagnosed the patient with tonsilitis and wrote a
prescription for antibiotics. Which of the following codes should the specialist use? -
Answer-✅99203
/.A provider accepts assignment for a patient who has a $10 copayment and has
already met $100 of their $150 deductible. The office charge is $100 and the allowed
amount is $70. How much should the provider's office adjust off the patient's account? -
Answer-✅$30
/.A patient has a new diagnosis of hypothyroidism. In which of the following body
systems is the thyroid gland located? - Answer-✅Endocrine system
/.A patient's portion of the bill should be discussed with the patient before a procedure is
performed for which of the following reasons? - Answer-✅To ensure the patient
understands how much they are responsible to pay
/.Which of the following introduced documentation guidelines to Medicare carriers to
ensure that services paid for have been provided and were medically necessary? -
Answer-✅CMS
/.A billing and coding specialist is reviewing a remittance advice for a claim that was
denied for medical necessity. Which of the following is an example of this type of error?
- Answer-✅The ICD-10-CM code for tonsillitis was listed with the CPT code for an
appendectomy
/.Which of the following physical status modifiers should a billing and coding specialist
use for anesthesia services performed on a healthy 4-year-old patient? - Answer-✅-P1
Questions With Complete Solutions
/. Which of the following is used to communicate why a claim line item was denied or
paid differently than it was billed? - Answer-✅Claims adjustment reason codes
/.A billing and coding specialist is reviewing a claim edit report and identifies a rejection
for missing patient demographic information. Which of the following missing pieces of
patient demographic information would cause rejection from the clearinghouse? -
Answer-✅Date of birth
/.A billing and coding specialist is reviewing paperwork that indicates overpayment by
Medicare for six patients over the past year. Which of the following describes this
process? - Answer-✅Audit
/.Which of the following describes an insurance company that offers plans that pay
health care providers who render services to patients? - Answer-✅Third-party payer
/.Which of the following sections of the CPT manual lists the code for WBC with
differential, automated? - Answer-✅Pathology and Laboratory
/.A billing and coding specialist is reviewing provider notes to complete a claim. They
need clarification on whether the procedure performed was on the left side, right side, or
bilaterally. The specialist queries the provider and the provider confirms it was a
bilateral procedure. Which of the following modifiers should be billed? - Answer-✅-50
/.A provider orders a comprehensive metabolic panel for a 70-year-old patient who has
Medicare as their primary insurance. Which of the following is required to inform the
patient they may be responsible for payment? - Answer-✅Advance Beneficiary Notice
/.A billing and coding specialist is appealing a Medicare denial. Which of the following is
the first step in the appeals process? - Answer-✅Redetermination
/.A patient has a history of breast cancer that has metastasized to the liver and is
undergoing chemotherapy today for the liver cancer. Which of the following ICD-10-CM
codes should be sequenced first? - Answer-✅Z51.11
/.Which of the following are used to code provider and outpatient services? - Answer-
✅CPT codes
, /.A patient who is insulin-dependent is diagnosed with diabetic retinopathy. According to
ICD-10-CM coding guidelines, in which of the following orders should the codes be
reported in the claim form? - Answer-✅E11.319, Z79.4
/.Which of the following is a covered entity affected by HIPAA security rules? - Answer-
✅Health care clearinghouses
/.Which of the following actions by a billing and coding specialist is an example of fraud?
- Answer-✅Billing for services not provided to obtain higher reimbursement
/.Which of the following should be included on a claim form that is sent from a specialist
to a managed health care organization? - Answer-✅The referring provider's national
provider identifier (NPI)
/.Which of the following is a document used to analyze accounts receivable based on
dates of service? - Answer-✅Aging report
/.A billing and coding specialist is processing a claim for a new patient who came to the
office for a sore throat. The provider diagnosed the patient with tonsilitis and wrote a
prescription for antibiotics. Which of the following codes should the specialist use? -
Answer-✅99203
/.A provider accepts assignment for a patient who has a $10 copayment and has
already met $100 of their $150 deductible. The office charge is $100 and the allowed
amount is $70. How much should the provider's office adjust off the patient's account? -
Answer-✅$30
/.A patient has a new diagnosis of hypothyroidism. In which of the following body
systems is the thyroid gland located? - Answer-✅Endocrine system
/.A patient's portion of the bill should be discussed with the patient before a procedure is
performed for which of the following reasons? - Answer-✅To ensure the patient
understands how much they are responsible to pay
/.Which of the following introduced documentation guidelines to Medicare carriers to
ensure that services paid for have been provided and were medically necessary? -
Answer-✅CMS
/.A billing and coding specialist is reviewing a remittance advice for a claim that was
denied for medical necessity. Which of the following is an example of this type of error?
- Answer-✅The ICD-10-CM code for tonsillitis was listed with the CPT code for an
appendectomy
/.Which of the following physical status modifiers should a billing and coding specialist
use for anesthesia services performed on a healthy 4-year-old patient? - Answer-✅-P1
