NHA CPT Exam Prep Questions and
Answers | Latest Version | 2025/2026 |
Correct & Verified
What is the main purpose of a patient encounter note?
✔✔To provide a complete record of patient care and support billing
Why is medical necessity important in CPT exam prep?
✔✔It justifies procedures and services for reimbursement
What should be documented when a patient refuses a recommended service?
✔✔The patient’s refusal, reason if given, and notification to the provider
Why is it important to record a patient’s chief complaint accurately?
✔✔It guides diagnosis, treatment, and service coding
What should be included in a follow-up visit documentation?
✔✔Patient progress, response to treatment, and any new concerns
1
,Why is time spent with a patient sometimes documented in detail?
✔✔It can determine the level of service and affect billing
How should a medical assistant handle simultaneous preventive and treatment services?
✔✔Document each service separately with clear descriptions
Why is documenting patient education important?
✔✔It supports compliance, understanding, and billing justification
What should be noted if a procedure is performed differently than planned?
✔✔Reason for variation and any modifications made
Why is documenting vital signs essential?
✔✔They provide baseline and ongoing data to guide care
What is the role of modifiers in reporting services?
✔✔They give additional information about how, when, or where a service was performed
2
,How should abnormal findings be recorded?
✔✔Clearly describe the finding, date, and provider’s action
Why should a medical assistant verify patient identity before any procedure?
✔✔To prevent errors and ensure safety
What should be documented when a patient is referred to another provider?
✔✔Reason for referral, relevant history, and test results
Why is it important to document informed consent?
✔✔To protect patient rights and provide legal protection for the provider
What is the significance of documenting a patient’s allergies?
✔✔It prevents adverse reactions and guides safe treatment
Why should a provider document the rationale for diagnostic tests?
✔✔To justify medical necessity and support reimbursement
3
, How should repeat procedures be documented?
✔✔Indicate that it is a repeat service and include relevant details
Why is it necessary to record patient responses to treatment?
✔✔It helps evaluate effectiveness and plan future care
What should be documented when multiple issues are addressed in one visit?
✔✔Separate each issue with history, exam, and plan
Why is documenting risk factors for chronic diseases important?
✔✔It guides preventive care and treatment decisions
How should a provider record complications during a procedure?
✔✔Document type, interventions, and outcome
Why is it important to document medication administration immediately?
✔✔To ensure accuracy and prevent errors
4
Answers | Latest Version | 2025/2026 |
Correct & Verified
What is the main purpose of a patient encounter note?
✔✔To provide a complete record of patient care and support billing
Why is medical necessity important in CPT exam prep?
✔✔It justifies procedures and services for reimbursement
What should be documented when a patient refuses a recommended service?
✔✔The patient’s refusal, reason if given, and notification to the provider
Why is it important to record a patient’s chief complaint accurately?
✔✔It guides diagnosis, treatment, and service coding
What should be included in a follow-up visit documentation?
✔✔Patient progress, response to treatment, and any new concerns
1
,Why is time spent with a patient sometimes documented in detail?
✔✔It can determine the level of service and affect billing
How should a medical assistant handle simultaneous preventive and treatment services?
✔✔Document each service separately with clear descriptions
Why is documenting patient education important?
✔✔It supports compliance, understanding, and billing justification
What should be noted if a procedure is performed differently than planned?
✔✔Reason for variation and any modifications made
Why is documenting vital signs essential?
✔✔They provide baseline and ongoing data to guide care
What is the role of modifiers in reporting services?
✔✔They give additional information about how, when, or where a service was performed
2
,How should abnormal findings be recorded?
✔✔Clearly describe the finding, date, and provider’s action
Why should a medical assistant verify patient identity before any procedure?
✔✔To prevent errors and ensure safety
What should be documented when a patient is referred to another provider?
✔✔Reason for referral, relevant history, and test results
Why is it important to document informed consent?
✔✔To protect patient rights and provide legal protection for the provider
What is the significance of documenting a patient’s allergies?
✔✔It prevents adverse reactions and guides safe treatment
Why should a provider document the rationale for diagnostic tests?
✔✔To justify medical necessity and support reimbursement
3
, How should repeat procedures be documented?
✔✔Indicate that it is a repeat service and include relevant details
Why is it necessary to record patient responses to treatment?
✔✔It helps evaluate effectiveness and plan future care
What should be documented when multiple issues are addressed in one visit?
✔✔Separate each issue with history, exam, and plan
Why is documenting risk factors for chronic diseases important?
✔✔It guides preventive care and treatment decisions
How should a provider record complications during a procedure?
✔✔Document type, interventions, and outcome
Why is it important to document medication administration immediately?
✔✔To ensure accuracy and prevent errors
4
