NHA BILLING CODING ANSWERS AND QUESTIONS
SET A+
✔✔1. A billing and coding specialist is preparing a claim for a patient who had a
procedure on their left index figure. Which of the following modifier indicates the correct
digit? - ✔✔F1
✔✔1. In which of the following sections of SOAP note does a provider indicate a
patient's reported level of pain? - ✔✔a. Subjective
✔✔1. Which of the following editing systems should a billing and coding specialist
reference to determine if a supplies tray used during and materials code should be
assigned to report a surgical tray used during an ambulatory procedure? - ✔✔a.
National Correct Coding Initiative (NCCI)
✔✔1. A patient wants to see and endocrinologist for a consultation about their diabetes
mellitus, but they must see their primary care provider (PCP) for a referral to an in-
network specialist first. Which of the following types of insurance does the patient have?
- ✔✔a. Health maintenance organization (HMO)
✔✔1. Which of the following are qualifying circumstances in the anesthesia section of
the CPT manual? - ✔✔a. Add-on codes
✔✔1. A billing and coding specialist is reviewing the procedure notes from a provider
who selected a code indicating an incisional biopsy when the entirety of the patient's
lesion was removed. The specialist should verify with the provider that which of the
following types of procedures was performed? - ✔✔a. Excisional procedure
✔✔1. A billing and coding specialist is determining coordination of benefits for a patient
who has health insurance coverage from both parents the patient's father's birthday is
May 18, 1982, and their mother's birthday is May 18, 1984. Which of the following
statements is correct for determining coverage? - ✔✔a. The parent whose insurance
policy has been active the longest will be the primary insurer
, ✔✔1. When a patient has a condition that is both acute and chronic, how should it be
coded? - ✔✔a. Code both the acute and chronic conditions, sequencing the acute
condition first
✔✔1. Outstanding patient balances will appear on which of the following? - ✔✔a.
Account receivable
✔✔1. A billing and coding specialist is posting a Medicare remittance advice and
identifies an overpayment of $15. Which of the following actions should the specialist
take? - ✔✔a. Notify Medicare about the overpayment within 60 days.
✔✔1. Which of the following is a federal government health insurance program? - ✔✔a.
TRICARE
✔✔1. Which of the following is used by Medicare to determine if an item or service is
covered? - ✔✔a. National Coverage Determination (NCD)
✔✔1. In an outpatient setting, which of the following terms is used as a financial report
of all services provided to patients? - ✔✔a. Patient account record
✔✔1. A billing and coding specialist is training a new employee on a claim for a
consultation. The new employee asks, "what is a consultation?" Which of the following
responses should the specialist make? - ✔✔a. "it's when a provider requests medical
advice from a specialist."
✔✔1. A billing and coding specialist is working on a claim in which reimbursement was
reduced due to services being bundled. Which of the following types of modifiers should
be assigned to indicate multiple procedures were preformed to prevent bundling? -
✔✔a. Category I modifier
✔✔1. On a remittance advice form, which of the following is responsible for writing off
the difference between the amount billed, and the amount allowed by the agreement? -
✔✔a. Provider
✔✔1. A billing and coding specialist is assisting a patient who has a capitated health
maintenance organization (HMO) and presents to the office with a sinus infection. The
specialist should identify that which of the following statements is true regarding a
capitated HMO? - ✔✔a. Payment for the encounter is based on a flat rate
✔✔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
SET A+
✔✔1. A billing and coding specialist is preparing a claim for a patient who had a
procedure on their left index figure. Which of the following modifier indicates the correct
digit? - ✔✔F1
✔✔1. In which of the following sections of SOAP note does a provider indicate a
patient's reported level of pain? - ✔✔a. Subjective
✔✔1. Which of the following editing systems should a billing and coding specialist
reference to determine if a supplies tray used during and materials code should be
assigned to report a surgical tray used during an ambulatory procedure? - ✔✔a.
National Correct Coding Initiative (NCCI)
✔✔1. A patient wants to see and endocrinologist for a consultation about their diabetes
mellitus, but they must see their primary care provider (PCP) for a referral to an in-
network specialist first. Which of the following types of insurance does the patient have?
- ✔✔a. Health maintenance organization (HMO)
✔✔1. Which of the following are qualifying circumstances in the anesthesia section of
the CPT manual? - ✔✔a. Add-on codes
✔✔1. A billing and coding specialist is reviewing the procedure notes from a provider
who selected a code indicating an incisional biopsy when the entirety of the patient's
lesion was removed. The specialist should verify with the provider that which of the
following types of procedures was performed? - ✔✔a. Excisional procedure
✔✔1. A billing and coding specialist is determining coordination of benefits for a patient
who has health insurance coverage from both parents the patient's father's birthday is
May 18, 1982, and their mother's birthday is May 18, 1984. Which of the following
statements is correct for determining coverage? - ✔✔a. The parent whose insurance
policy has been active the longest will be the primary insurer
, ✔✔1. When a patient has a condition that is both acute and chronic, how should it be
coded? - ✔✔a. Code both the acute and chronic conditions, sequencing the acute
condition first
✔✔1. Outstanding patient balances will appear on which of the following? - ✔✔a.
Account receivable
✔✔1. A billing and coding specialist is posting a Medicare remittance advice and
identifies an overpayment of $15. Which of the following actions should the specialist
take? - ✔✔a. Notify Medicare about the overpayment within 60 days.
✔✔1. Which of the following is a federal government health insurance program? - ✔✔a.
TRICARE
✔✔1. Which of the following is used by Medicare to determine if an item or service is
covered? - ✔✔a. National Coverage Determination (NCD)
✔✔1. In an outpatient setting, which of the following terms is used as a financial report
of all services provided to patients? - ✔✔a. Patient account record
✔✔1. A billing and coding specialist is training a new employee on a claim for a
consultation. The new employee asks, "what is a consultation?" Which of the following
responses should the specialist make? - ✔✔a. "it's when a provider requests medical
advice from a specialist."
✔✔1. A billing and coding specialist is working on a claim in which reimbursement was
reduced due to services being bundled. Which of the following types of modifiers should
be assigned to indicate multiple procedures were preformed to prevent bundling? -
✔✔a. Category I modifier
✔✔1. On a remittance advice form, which of the following is responsible for writing off
the difference between the amount billed, and the amount allowed by the agreement? -
✔✔a. Provider
✔✔1. A billing and coding specialist is assisting a patient who has a capitated health
maintenance organization (HMO) and presents to the office with a sinus infection. The
specialist should identify that which of the following statements is true regarding a
capitated HMO? - ✔✔a. Payment for the encounter is based on a flat rate
✔✔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
