NHA Billing and Coding Practice Test with
Answers Graded A+ Already!!
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 entities should the specialist contact to report the
payer's failure to submit timely reimbursement? - a. State Insurance
Commissioner's office
1. Which of the following is an example of a diagnostic category code? -
a. I10
1. The star symbol in the CPT coding manual is used to indicate which of the
following? - a. Telemedicine
1. Which of the following is an advantage of electronic claim submission? -
a. Claims are expedited
1. When should a billing and coding specialist initiate the collection of the
information needed to process a patient's insurance claim form? - a.
When the patient contacts the provider's office and schedules an
appointment
1. A billing and coding specialist is reviewing modifier use with a new
employee. Which of the following scenarios warrants the use of a modifier? -
1
a. Splinting of the fourth digit on the left foot
Page
,1. A billing and coding specialist is reviewing a provider's documentation for a
patient who underwent repair of multiple wounds to the face and trunk. The
provider coded repair of all wounds individually. The specialist should
recognize that the provider should have applied which of the following
concepts to the documentation of the repair for this patient's wounds? -
a. Wounds should be grouped by anatomic site and coded in order of
complexity
1. Which of the following terms describe the removal of the eye, adnexa, and
bony structure? - a. Exenteration
1. A billing and coding specialist is reviewing delinquent claims and discovers
that a third-party payer paid a claim but applied it to the incorrect provider.
The third-party payer will reimburse the payment once the improperly paid
funds are recouped. Which of the following terms is used to describe this
claim? - a. Suspended
1. For which of the following reasons should a claim be resubmitted? -
a. The claim requires an attachment to support medical necessity
1. A billing and coding specialist is preparing an account receivable aging
report. The specialist should expect the report to include which of the
following? - a. Outstanding balances organized by date
1. Which of the following pieces of guarantor information is required when
2
establishing a patient's financial record? - a. Phone number
Page
, 1. Which of the following actions by a billing and coding specialist ensures a
patient's health information is protected? - a. Using data encryption
software on office workstations
1. A billing and coding specialist is preparing an appeal letter in response to a
denial by a third-party payer for lack of medical necessity. Which of the
following should the specialist include with the letter to indicate medical
necessity? - a. Medical record documentation
1. A child is brought into a facility by their mother. The child is cover under
both parents' insurance policies. The child's father was born on 10/1/1980 and
their mother was born on 10/2/1921. Which of the following statements is true
regarding the primary policy holder for the child? - a. The father is the
primary policy holder because his birthday falls first in the calendar year
1. A billing and coding specialist is processing a claim for a patient who broke
their arm while repairing cars at their workplace. There is no nerve damage,
the arm is placed in a cast for 6 weeks, and the patient is cleared to return to
work in 6 weeks. Which of the following types of workers' compensation
applies to this patient? - a. Temporary disability
1. Which of the following information is required on a patient account
required? - a. Name and address of guarantor
3
Page
Answers Graded A+ Already!!
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 entities should the specialist contact to report the
payer's failure to submit timely reimbursement? - a. State Insurance
Commissioner's office
1. Which of the following is an example of a diagnostic category code? -
a. I10
1. The star symbol in the CPT coding manual is used to indicate which of the
following? - a. Telemedicine
1. Which of the following is an advantage of electronic claim submission? -
a. Claims are expedited
1. When should a billing and coding specialist initiate the collection of the
information needed to process a patient's insurance claim form? - a.
When the patient contacts the provider's office and schedules an
appointment
1. A billing and coding specialist is reviewing modifier use with a new
employee. Which of the following scenarios warrants the use of a modifier? -
1
a. Splinting of the fourth digit on the left foot
Page
,1. A billing and coding specialist is reviewing a provider's documentation for a
patient who underwent repair of multiple wounds to the face and trunk. The
provider coded repair of all wounds individually. The specialist should
recognize that the provider should have applied which of the following
concepts to the documentation of the repair for this patient's wounds? -
a. Wounds should be grouped by anatomic site and coded in order of
complexity
1. Which of the following terms describe the removal of the eye, adnexa, and
bony structure? - a. Exenteration
1. A billing and coding specialist is reviewing delinquent claims and discovers
that a third-party payer paid a claim but applied it to the incorrect provider.
The third-party payer will reimburse the payment once the improperly paid
funds are recouped. Which of the following terms is used to describe this
claim? - a. Suspended
1. For which of the following reasons should a claim be resubmitted? -
a. The claim requires an attachment to support medical necessity
1. A billing and coding specialist is preparing an account receivable aging
report. The specialist should expect the report to include which of the
following? - a. Outstanding balances organized by date
1. Which of the following pieces of guarantor information is required when
2
establishing a patient's financial record? - a. Phone number
Page
, 1. Which of the following actions by a billing and coding specialist ensures a
patient's health information is protected? - a. Using data encryption
software on office workstations
1. A billing and coding specialist is preparing an appeal letter in response to a
denial by a third-party payer for lack of medical necessity. Which of the
following should the specialist include with the letter to indicate medical
necessity? - a. Medical record documentation
1. A child is brought into a facility by their mother. The child is cover under
both parents' insurance policies. The child's father was born on 10/1/1980 and
their mother was born on 10/2/1921. Which of the following statements is true
regarding the primary policy holder for the child? - a. The father is the
primary policy holder because his birthday falls first in the calendar year
1. A billing and coding specialist is processing a claim for a patient who broke
their arm while repairing cars at their workplace. There is no nerve damage,
the arm is placed in a cast for 6 weeks, and the patient is cleared to return to
work in 6 weeks. Which of the following types of workers' compensation
applies to this patient? - a. Temporary disability
1. Which of the following information is required on a patient account
required? - a. Name and address of guarantor
3
Page
