NHA Medical Billing and Coding Final Prac ce Test 2025
Which of the following is a key protec on standard of the HIPAA Privacy Rule that requires
covered en es and business associates to limit the use or release of protected health
informa on (PHI)? - Ans Disclosure
A billing and coding specialist is preparing a claim that includes a code for a miscellaneous
supply. Which of the following ac ons should the specialist take to ensure the claim will be paid
the first me it is submi'ed? - Ans Add supplemental documenta on with the claim.
Which of the following describes the status of a claim that is in process and does not include
required preauthoriza on for a service? - Ans denied
A third-party payer requests a pa ent's informa on related to a claim. A billing and coding
specialist should ensure that which of the following is included in the pa ent's file before
providing the informa on? - Ans signed release of informa on form
Coding manuals use which of the following conven ons? - Ans Icons
A billing and coding specialist is using an accounts receivable aging report to determine which
accounts should be sent to collec ons. According to best prac ces, which of the following
accounts should the specialist send to collec ons? - Ans An account that has a balance of $600
and is 135 days old
Which of the following CPT® codes should a billing and coding specialist use to indicate a total
prostate-specific an gen (PSA) test? - Ans 84153 Prostate specific an gen (PSA); Total
Which of the following is the purpose of a claims clearinghouse? - Ans To iden fy errors that
will prevent a claim from being paid
,Which of the following describes a claim that is 120 days old? - Ans Delinquent
Which of the following government agencies is responsible for comba ng fraud and abuse in
health insurance and health care delivery? - Ans Office of Inspector General (OIG)
Which of the following plans requires providers to adhere to managed care provisions? - Ans
Health maintenance organiza on (HMO) plan
Which of the following are included in the ICD-10-CM code set? - Ans Spiral fracture
Which of the following codes are used to code diseases, injuries, impairments, and other
health-related problems? - Ans ICD-10-CM codes
An internal retrospec ve billing account audit prevents fraud and abuse by reviewing and
comparing completed claim forms with which of the following? - Ans Documenta on of
compliance plans
Which of the following types of insurance do healthcare professionals purchase to protect
themselves from liability rela ng to claims arising from pa ent treatments? - Ans Medical
malprac ce
A new pa ent is seen in the office for frequent urina on and excessive thirst. The provider
performs a detailed history and examina on. Which of the following coding manuals should a
billing and coding specialist reference to determine the Evalua on and Management (E/M) level
of care for this visit? - Ans CPT
A billing and coding specialist should consider which of the following when determining an
Evalua on and Management (E/M) code? - Ans Place of service
, A billing and coding specialist is preparing a claim for a pa ent who had an Evalua on and
Management (E/M) visit for abdominal pain that resulted in the decision to remove the
appendix immediately. Which of the following modifiers should the specialist use for this claim?
- Ans -57
A pa ent who has a past due balance requests their records be sent to another provider. Which
of the following ac ons should the billing and coding specialist take with regard to the records
request? - Ans Begin collec on ac on on the balance due.
ACer a third-party payer validates a claim, which of the following takes place next? - Ans Claim
adjudica on
How many days aCer receipt of an ini al demand le'er from a Medicare administra ve
contractor (MAC) does a provider have to return an overpayment of $25 or more without
accruing interest? - Ans 30 days
A billing and coding specialist is conduc ng an internal audit to analyze reimbursement for a
provider prac ce. Which of the following should the specialist understand is the basis for
reimbursement? - Ans Rela ve value units (RVUs)
A billing and coding specialist is preparing to submit a claim for a service that requires
preauthoriza on. Preauthoriza on must be requested by which of the following individuals? -
Ans Trea ng provider
Which of the following can be performed when billing procedural codes? - Ans Billing using
two-digit CPT® modifiers to indicate a procedure performed differs from the usual five-digit
code
A billing and coding specialist is reviewing the CPT® coding manual with a trainee. The trainee
asks why the Evalua on and Management (E/M) codes are located in the front of the manual
Which of the following is a key protec on standard of the HIPAA Privacy Rule that requires
covered en es and business associates to limit the use or release of protected health
informa on (PHI)? - Ans Disclosure
A billing and coding specialist is preparing a claim that includes a code for a miscellaneous
supply. Which of the following ac ons should the specialist take to ensure the claim will be paid
the first me it is submi'ed? - Ans Add supplemental documenta on with the claim.
Which of the following describes the status of a claim that is in process and does not include
required preauthoriza on for a service? - Ans denied
A third-party payer requests a pa ent's informa on related to a claim. A billing and coding
specialist should ensure that which of the following is included in the pa ent's file before
providing the informa on? - Ans signed release of informa on form
Coding manuals use which of the following conven ons? - Ans Icons
A billing and coding specialist is using an accounts receivable aging report to determine which
accounts should be sent to collec ons. According to best prac ces, which of the following
accounts should the specialist send to collec ons? - Ans An account that has a balance of $600
and is 135 days old
Which of the following CPT® codes should a billing and coding specialist use to indicate a total
prostate-specific an gen (PSA) test? - Ans 84153 Prostate specific an gen (PSA); Total
Which of the following is the purpose of a claims clearinghouse? - Ans To iden fy errors that
will prevent a claim from being paid
,Which of the following describes a claim that is 120 days old? - Ans Delinquent
Which of the following government agencies is responsible for comba ng fraud and abuse in
health insurance and health care delivery? - Ans Office of Inspector General (OIG)
Which of the following plans requires providers to adhere to managed care provisions? - Ans
Health maintenance organiza on (HMO) plan
Which of the following are included in the ICD-10-CM code set? - Ans Spiral fracture
Which of the following codes are used to code diseases, injuries, impairments, and other
health-related problems? - Ans ICD-10-CM codes
An internal retrospec ve billing account audit prevents fraud and abuse by reviewing and
comparing completed claim forms with which of the following? - Ans Documenta on of
compliance plans
Which of the following types of insurance do healthcare professionals purchase to protect
themselves from liability rela ng to claims arising from pa ent treatments? - Ans Medical
malprac ce
A new pa ent is seen in the office for frequent urina on and excessive thirst. The provider
performs a detailed history and examina on. Which of the following coding manuals should a
billing and coding specialist reference to determine the Evalua on and Management (E/M) level
of care for this visit? - Ans CPT
A billing and coding specialist should consider which of the following when determining an
Evalua on and Management (E/M) code? - Ans Place of service
, A billing and coding specialist is preparing a claim for a pa ent who had an Evalua on and
Management (E/M) visit for abdominal pain that resulted in the decision to remove the
appendix immediately. Which of the following modifiers should the specialist use for this claim?
- Ans -57
A pa ent who has a past due balance requests their records be sent to another provider. Which
of the following ac ons should the billing and coding specialist take with regard to the records
request? - Ans Begin collec on ac on on the balance due.
ACer a third-party payer validates a claim, which of the following takes place next? - Ans Claim
adjudica on
How many days aCer receipt of an ini al demand le'er from a Medicare administra ve
contractor (MAC) does a provider have to return an overpayment of $25 or more without
accruing interest? - Ans 30 days
A billing and coding specialist is conduc ng an internal audit to analyze reimbursement for a
provider prac ce. Which of the following should the specialist understand is the basis for
reimbursement? - Ans Rela ve value units (RVUs)
A billing and coding specialist is preparing to submit a claim for a service that requires
preauthoriza on. Preauthoriza on must be requested by which of the following individuals? -
Ans Trea ng provider
Which of the following can be performed when billing procedural codes? - Ans Billing using
two-digit CPT® modifiers to indicate a procedure performed differs from the usual five-digit
code
A billing and coding specialist is reviewing the CPT® coding manual with a trainee. The trainee
asks why the Evalua on and Management (E/M) codes are located in the front of the manual
