NHA BILLING AND CODING PRACTICE
TEST ACTUAL EXAM QUESTIONS
WITH DETAILED VERIFIED ANSWERS
ALREADY GRADED A+ GUARANTEED
PASS!
"A claim is submitted with a transposed insurance member ID number and returned to the
provider. Which of the following describes the status that will be assigned to the claim by the
third-party payer? - CORRECT ANSWER=> a. Invalid"
"A billing and coding specialist is reviewing a claim for a patient who presented to the provider's
office for an upper respiratory infection. During the encounter, the patient also received the
influenza vaccine. Which of the following modifiers should be attached to the Evaluation and
Management (E/M) code? - CORRECT ANSWER=> -25"
"Which of the following is a valid ICD-10-CM principle? - CORRECT ANSWER=> a. Code signs and
symptoms in the absence of a definite diagnosis"
"Which of the following entities are required to follow HIPAA rules and regulations? - CORRECT
ANSWER=> a. Clearinghouses, health insurance companies, and billing services"
"Which of the following information is correct regarding code symbols in the CPT manual? -
CORRECT ANSWER=> a. A product pending FDA approval is indicated by a lightning bolt symbol"
"A billing and coding specialist should add modifier -50 to a code when reporting which of the
following? - CORRECT ANSWER=> a. A bilateral procedure"
"An explanation of benefits states the amount billed was $60, and the patient is required to pay
a $20 copayment. Which of the following describes the insurance check amount to be posted? -
CORRECT ANSWER=> $40"
1|Page
,"A billing and coding specialist is reviewing a remittance advice and encounters a denial of
payment for a CPT code 44950 (appendectomy). The specialist discovers the ICD-10-CM code
assigned to the claim was J32.1 (chronic frontal sinusitis). Which of the following is the reason
for this claim denial? - CORRECT ANSWER=> a. Incorrectly linked codes were reported on the
claim"
"A billing and coding specialist receives a denial for payment from TRICARE for services provided
in the emergency department while a provider was on call. The provider is not a participating
TRICARE provider. Which of the following actions must the specialist take to process an appeal
for payment? - CORRECT ANSWER=> a. Contact the patient for assistance"
"Which of the following is the third state of a claim's life cycle? - CORRECT ANSWER=> a.
Adjudication"
"For which of the following reasons should a billing and coding specialist follow the guidelines in
the CPT manual? - CORRECT ANSWER=> a. The guidelines define items that are necessary to
accurately code"
"1. A billing and coding specialist should identify that which of the following is used to improve
this effectively and effectiveness of the health care system as mandated by HIPAA for providers?
- CORRECT ANSWER=> a. CMS-1500 claim form"
"Which of the following is the provisions of health insurance policies that specifics which
coverage is primary or secondary? - CORRECT ANSWER=> a. Coordination of benefits"
"An employer's worker's compensation payer requires blood work for an employee who
experienced a work-related injury. Which of the following modifiers should should a billing and
coding specialist take? - CORRECT ANSWER=> -32"
"Medigap coverage is offered to Medicare beneficiaries by which of the following? - CORRECT
ANSWER=> a. Private third-party payers"
"Which of the following statement is true regarding the release of patient information? -
CORRECT ANSWER=> a. Patient access to psychotherapy notes is restricted"
"Which of the following is true regarding Medicaid eligibility? - CORRECT ANSWER=> a. Patient
eligibility is determined at each visit"
2|Page
, "A billing and coding specialist is reviewing a patient's encounter progress note. Which of the
following modifiers indicate the patient received general anesthesia from an surgeon? -
CORRECT ANSWER=> -47"
"A billing and coding specialist is reviewing a claim for an established patient who arrived at the
office with an upper respiratory infection. Which of the following codes should the specifically
use for this encounter? - CORRECT ANSWER=> a. 99213"
"A billing and coding specialist observes a colleague preform an unethical act. Which of the
following actions should the specialist take? - CORRECT ANSWER=> a. Report the incident to a
supervisor"
"A billing and coding specialist is preparing a claim for a provider. The operative note indicates
the surgeon performed a CABG. The specialist should identify that CABG stands for which of the
following? - CORRECT ANSWER=> a. Coronary artery bypass graft"
"A patient presents to a primary care provider for a closed index finger fracture. The provider is
a non-participating provider for a private payer and does not accept assignment of benefits. The
provider's charge for service is $135. The third-party payer's usual customary reasonable (UCR)
amount is $120 with 20% coinsurance. Which of the following is the patients responsibility? -
CORRECT ANSWER=> $39"
"A billing and coding specialist is arranging a payment plan with a patient who wants to leave to
post dated checks with the office. The patients proposes leaving one check post dated for 3
months, one for 4 months, and one for 5 months in the future. According to the federal
collection law, which of the following actions should the specialist take? - CORRECT ANSWER=> a.
Notify the patient between 3 and 10 days prior to depositing each check on the indicated
dated"
"A patient has a resection of the intestines with a anastomosis through the abdominal wall.
Which of the following is a type of anastomosis? - CORRECT ANSWER=> a. Colostomy"
"A billing and coding specialist is preparing to appeal a partially paid claim due to an incorrect
procedure code. Which of the following steps of the appeal process includes the review of the
claim adjustment reason code? - CORRECT ANSWER=> a. Identification"
"Which of the following is a part of a provider's practice compliance program? - CORRECT
ANSWER=> a. Internal monitoring and auditing"
3|Page
TEST ACTUAL EXAM QUESTIONS
WITH DETAILED VERIFIED ANSWERS
ALREADY GRADED A+ GUARANTEED
PASS!
"A claim is submitted with a transposed insurance member ID number and returned to the
provider. Which of the following describes the status that will be assigned to the claim by the
third-party payer? - CORRECT ANSWER=> a. Invalid"
"A billing and coding specialist is reviewing a claim for a patient who presented to the provider's
office for an upper respiratory infection. During the encounter, the patient also received the
influenza vaccine. Which of the following modifiers should be attached to the Evaluation and
Management (E/M) code? - CORRECT ANSWER=> -25"
"Which of the following is a valid ICD-10-CM principle? - CORRECT ANSWER=> a. Code signs and
symptoms in the absence of a definite diagnosis"
"Which of the following entities are required to follow HIPAA rules and regulations? - CORRECT
ANSWER=> a. Clearinghouses, health insurance companies, and billing services"
"Which of the following information is correct regarding code symbols in the CPT manual? -
CORRECT ANSWER=> a. A product pending FDA approval is indicated by a lightning bolt symbol"
"A billing and coding specialist should add modifier -50 to a code when reporting which of the
following? - CORRECT ANSWER=> a. A bilateral procedure"
"An explanation of benefits states the amount billed was $60, and the patient is required to pay
a $20 copayment. Which of the following describes the insurance check amount to be posted? -
CORRECT ANSWER=> $40"
1|Page
,"A billing and coding specialist is reviewing a remittance advice and encounters a denial of
payment for a CPT code 44950 (appendectomy). The specialist discovers the ICD-10-CM code
assigned to the claim was J32.1 (chronic frontal sinusitis). Which of the following is the reason
for this claim denial? - CORRECT ANSWER=> a. Incorrectly linked codes were reported on the
claim"
"A billing and coding specialist receives a denial for payment from TRICARE for services provided
in the emergency department while a provider was on call. The provider is not a participating
TRICARE provider. Which of the following actions must the specialist take to process an appeal
for payment? - CORRECT ANSWER=> a. Contact the patient for assistance"
"Which of the following is the third state of a claim's life cycle? - CORRECT ANSWER=> a.
Adjudication"
"For which of the following reasons should a billing and coding specialist follow the guidelines in
the CPT manual? - CORRECT ANSWER=> a. The guidelines define items that are necessary to
accurately code"
"1. A billing and coding specialist should identify that which of the following is used to improve
this effectively and effectiveness of the health care system as mandated by HIPAA for providers?
- CORRECT ANSWER=> a. CMS-1500 claim form"
"Which of the following is the provisions of health insurance policies that specifics which
coverage is primary or secondary? - CORRECT ANSWER=> a. Coordination of benefits"
"An employer's worker's compensation payer requires blood work for an employee who
experienced a work-related injury. Which of the following modifiers should should a billing and
coding specialist take? - CORRECT ANSWER=> -32"
"Medigap coverage is offered to Medicare beneficiaries by which of the following? - CORRECT
ANSWER=> a. Private third-party payers"
"Which of the following statement is true regarding the release of patient information? -
CORRECT ANSWER=> a. Patient access to psychotherapy notes is restricted"
"Which of the following is true regarding Medicaid eligibility? - CORRECT ANSWER=> a. Patient
eligibility is determined at each visit"
2|Page
, "A billing and coding specialist is reviewing a patient's encounter progress note. Which of the
following modifiers indicate the patient received general anesthesia from an surgeon? -
CORRECT ANSWER=> -47"
"A billing and coding specialist is reviewing a claim for an established patient who arrived at the
office with an upper respiratory infection. Which of the following codes should the specifically
use for this encounter? - CORRECT ANSWER=> a. 99213"
"A billing and coding specialist observes a colleague preform an unethical act. Which of the
following actions should the specialist take? - CORRECT ANSWER=> a. Report the incident to a
supervisor"
"A billing and coding specialist is preparing a claim for a provider. The operative note indicates
the surgeon performed a CABG. The specialist should identify that CABG stands for which of the
following? - CORRECT ANSWER=> a. Coronary artery bypass graft"
"A patient presents to a primary care provider for a closed index finger fracture. The provider is
a non-participating provider for a private payer and does not accept assignment of benefits. The
provider's charge for service is $135. The third-party payer's usual customary reasonable (UCR)
amount is $120 with 20% coinsurance. Which of the following is the patients responsibility? -
CORRECT ANSWER=> $39"
"A billing and coding specialist is arranging a payment plan with a patient who wants to leave to
post dated checks with the office. The patients proposes leaving one check post dated for 3
months, one for 4 months, and one for 5 months in the future. According to the federal
collection law, which of the following actions should the specialist take? - CORRECT ANSWER=> a.
Notify the patient between 3 and 10 days prior to depositing each check on the indicated
dated"
"A patient has a resection of the intestines with a anastomosis through the abdominal wall.
Which of the following is a type of anastomosis? - CORRECT ANSWER=> a. Colostomy"
"A billing and coding specialist is preparing to appeal a partially paid claim due to an incorrect
procedure code. Which of the following steps of the appeal process includes the review of the
claim adjustment reason code? - CORRECT ANSWER=> a. Identification"
"Which of the following is a part of a provider's practice compliance program? - CORRECT
ANSWER=> a. Internal monitoring and auditing"
3|Page
