NHA BILLING AND CODING TEST 2025/2026 BANK
CURRENTLY TESTING COMPLETE QUESTIONS
WITH DETAILED VERIFIED ANSWERS /ALREADY
GRADED A+.
1. What is the primary purpose of the ICD-10-CM coding system?
...Answer... To classify and code diagnoses, symptoms, and reasons for patient encounters. It
provides a standardized system for morbidity (disease) tracking and reimbursement.
2. Define the term "medical necessity" in the context of healthcare billing.
...Answer... A service or procedure is considered medically necessary if it is appropriate for the
diagnosis and treatment of a patient's condition according to accepted standards of medical
practice.
3. What is the difference between a copayment and coinsurance?
...Answer... A copayment is a fixed amount (e.g., $20) a patient pays for a covered service.
Coinsurance is a percentage (e.g., 20%) of the cost of a covered service that the patient pays after
the deductible has been met.
4. List the three key components required for selecting an appropriate level of Evaluation and
Management (E/M) service.
...Answer... History, Examination, and Medical Decision Making. (Counseling and Coordination
of Care may also be factors, but the three main components are History, Exam, and MDM).
5. What does the acronym HIPAA stand for?
...Answer... Health Insurance Portability and Accountability Act.
6. Which official coding guideline instructs you to code a chronic condition as many times as the
patient receives treatment for it?
...Answer... The ICD-10-CM guideline that states: "Code all documented conditions that coexist
at the time of the encounter/visit, and require or affect patient care, treatment, or management."
7. What is the purpose of a CMS-1500 form?
,...Answer... It is the standard claim form used by non-institutional providers (e.g., physicians,
clinics) to bill Medicare and other health insurance payers for professional services.
8. A patient's insurance card lists "80/20" after the deductible. What does this mean?
...Answer... This refers to coinsurance. The insurance payer will cover 80% of the allowed
amount for covered services, and the patient is responsible for the remaining 20%.
9. What is the term for the predetermined amount that a health plan pays for a specific service,
which may be different from the provider's charged amount?
...Answer... The allowed amount, also known as the allowable charge.
10. Describe what an "open-book" account in a practice management system typically signifies.
...Answer... It signifies that the patient has an outstanding balance that is due and payable.
11. What is the main function of the CPT coding system?
...Answer... To report medical procedures and services performed by healthcare providers to
payers for reimbursement.
12. When is it appropriate to use an ICD-10-CM "Z" code?
...Answer... For encounters when the reason for the visit is something other than a disease or
injury, such as a health status encounter (e.g., annual exam, vaccination), circumstances
influencing health status, or contact/exposure to communicable diseases.
13. What is the difference between fraud and abuse?
...Answer... Fraud is an intentional act to deceive for an unlawful gain (e.g., billing for services
not rendered). Abuse involves practices that are inconsistent with sound medical/business
practices and result in unnecessary costs, but lack the proven intent of fraud.
14. What information is typically contained in a "superbill" or encounter form?
...Answer... A list of common CPT and ICD-10 codes specific to that practice, along with service
descriptions and charges, used to quickly document services provided during a patient visit.
,15. Which modifier would you append to a procedure code to indicate that it was performed on
the left side of the body?
...Answer... Modifier LT.
16. What is the purpose of the National Correct Coding Initiative (NCCI)?
...Answer... To prevent improper payment when certain CPT codes are reported together for the
same patient on the same date of service by the same provider (i.e., to prevent "unbundling").
17. Define "accounts receivable" (A/R) in a medical practice.
...Answer... The money owed to a medical practice by patients and third-party payers for services
that have been provided but not yet paid for.
18. What is an EOB, and who sends it?
...Answer... An Explanation of Benefits (EOB) is a statement sent by an insurance company to
both the provider and the patient, explaining what services were paid for, the allowed amount,
the amount paid by the insurer, and the patient's responsibility.
19. A patient fails to show up for a scheduled appointment. What type of CPT code might be
used for this situation?
...Answer... A CPT code for a no-show is not typically billed to insurance, as no service was
provided. However, practices may use a specific internal code (like 99199) or a charge code to
bill the patient directly if their policy allows for a no-show fee.
20. What does the term "triage" mean in a clinical setting?
...Answer... The process of determining the priority of patients' treatments based on the severity
of their condition.
21. What is the standard time limit for submitting a Medicare claim?
...Answer... Medicare claims must be filed no later than 12 months (1 calendar year) from the
date the service was provided.
22. In ICD-10-CM, what does the "X" placeholder character signify in a code?
, ...Answer... The "X" placeholder is used in certain codes to allow for future expansion. It holds a
space to make the code the correct number of characters. The 7th character is a common place
for the "X" in injury and external cause codes.
23. What is a "clean claim"?
...Answer... A claim that has no errors or missing information and can be processed without
manual intervention, leading to faster payment.
24. Name the four types of medical decision making (MDM) recognized in E/M guidelines.
...Answer... Straightforward, Low, Moderate, and High.
25. What is the role of a clearinghouse in the medical billing process?
...Answer... To act as an intermediary that receives claims from providers, checks them for errors,
formats them to meet the specific requirements of each insurance payer, and then forwards them
electronically.
26. When a patient is seen for a postoperative complication that is unrelated to the original
surgery, what modifier would be appended to the E/M service code?
...Answer... Modifier 24 (Unrelated Evaluation and Management Service by the Same Physician
or Other Qualified Health Care Professional During a Postoperative Period).
27. What is the term for the process of following up on unpaid or underpaid insurance claims?
...Answer... Accounts Receivable (A/R) Follow-up or Claims Follow-up.
28. What does the acronym ABN stand for, and what is its purpose?
...Answer... Advance Beneficiary Notice of Noncoverage. It is a form given to a Medicare patient
to inform them that a service may not be covered by Medicare, and if it is not, they will be
financially responsible for the cost.
29. In HIPAA, what does the "Privacy Rule" protect?
...Answer... It protects all "individually identifiable health information" held or transmitted by a
covered entity, in any form. This is known as Protected Health Information (PHI).
CURRENTLY TESTING COMPLETE QUESTIONS
WITH DETAILED VERIFIED ANSWERS /ALREADY
GRADED A+.
1. What is the primary purpose of the ICD-10-CM coding system?
...Answer... To classify and code diagnoses, symptoms, and reasons for patient encounters. It
provides a standardized system for morbidity (disease) tracking and reimbursement.
2. Define the term "medical necessity" in the context of healthcare billing.
...Answer... A service or procedure is considered medically necessary if it is appropriate for the
diagnosis and treatment of a patient's condition according to accepted standards of medical
practice.
3. What is the difference between a copayment and coinsurance?
...Answer... A copayment is a fixed amount (e.g., $20) a patient pays for a covered service.
Coinsurance is a percentage (e.g., 20%) of the cost of a covered service that the patient pays after
the deductible has been met.
4. List the three key components required for selecting an appropriate level of Evaluation and
Management (E/M) service.
...Answer... History, Examination, and Medical Decision Making. (Counseling and Coordination
of Care may also be factors, but the three main components are History, Exam, and MDM).
5. What does the acronym HIPAA stand for?
...Answer... Health Insurance Portability and Accountability Act.
6. Which official coding guideline instructs you to code a chronic condition as many times as the
patient receives treatment for it?
...Answer... The ICD-10-CM guideline that states: "Code all documented conditions that coexist
at the time of the encounter/visit, and require or affect patient care, treatment, or management."
7. What is the purpose of a CMS-1500 form?
,...Answer... It is the standard claim form used by non-institutional providers (e.g., physicians,
clinics) to bill Medicare and other health insurance payers for professional services.
8. A patient's insurance card lists "80/20" after the deductible. What does this mean?
...Answer... This refers to coinsurance. The insurance payer will cover 80% of the allowed
amount for covered services, and the patient is responsible for the remaining 20%.
9. What is the term for the predetermined amount that a health plan pays for a specific service,
which may be different from the provider's charged amount?
...Answer... The allowed amount, also known as the allowable charge.
10. Describe what an "open-book" account in a practice management system typically signifies.
...Answer... It signifies that the patient has an outstanding balance that is due and payable.
11. What is the main function of the CPT coding system?
...Answer... To report medical procedures and services performed by healthcare providers to
payers for reimbursement.
12. When is it appropriate to use an ICD-10-CM "Z" code?
...Answer... For encounters when the reason for the visit is something other than a disease or
injury, such as a health status encounter (e.g., annual exam, vaccination), circumstances
influencing health status, or contact/exposure to communicable diseases.
13. What is the difference between fraud and abuse?
...Answer... Fraud is an intentional act to deceive for an unlawful gain (e.g., billing for services
not rendered). Abuse involves practices that are inconsistent with sound medical/business
practices and result in unnecessary costs, but lack the proven intent of fraud.
14. What information is typically contained in a "superbill" or encounter form?
...Answer... A list of common CPT and ICD-10 codes specific to that practice, along with service
descriptions and charges, used to quickly document services provided during a patient visit.
,15. Which modifier would you append to a procedure code to indicate that it was performed on
the left side of the body?
...Answer... Modifier LT.
16. What is the purpose of the National Correct Coding Initiative (NCCI)?
...Answer... To prevent improper payment when certain CPT codes are reported together for the
same patient on the same date of service by the same provider (i.e., to prevent "unbundling").
17. Define "accounts receivable" (A/R) in a medical practice.
...Answer... The money owed to a medical practice by patients and third-party payers for services
that have been provided but not yet paid for.
18. What is an EOB, and who sends it?
...Answer... An Explanation of Benefits (EOB) is a statement sent by an insurance company to
both the provider and the patient, explaining what services were paid for, the allowed amount,
the amount paid by the insurer, and the patient's responsibility.
19. A patient fails to show up for a scheduled appointment. What type of CPT code might be
used for this situation?
...Answer... A CPT code for a no-show is not typically billed to insurance, as no service was
provided. However, practices may use a specific internal code (like 99199) or a charge code to
bill the patient directly if their policy allows for a no-show fee.
20. What does the term "triage" mean in a clinical setting?
...Answer... The process of determining the priority of patients' treatments based on the severity
of their condition.
21. What is the standard time limit for submitting a Medicare claim?
...Answer... Medicare claims must be filed no later than 12 months (1 calendar year) from the
date the service was provided.
22. In ICD-10-CM, what does the "X" placeholder character signify in a code?
, ...Answer... The "X" placeholder is used in certain codes to allow for future expansion. It holds a
space to make the code the correct number of characters. The 7th character is a common place
for the "X" in injury and external cause codes.
23. What is a "clean claim"?
...Answer... A claim that has no errors or missing information and can be processed without
manual intervention, leading to faster payment.
24. Name the four types of medical decision making (MDM) recognized in E/M guidelines.
...Answer... Straightforward, Low, Moderate, and High.
25. What is the role of a clearinghouse in the medical billing process?
...Answer... To act as an intermediary that receives claims from providers, checks them for errors,
formats them to meet the specific requirements of each insurance payer, and then forwards them
electronically.
26. When a patient is seen for a postoperative complication that is unrelated to the original
surgery, what modifier would be appended to the E/M service code?
...Answer... Modifier 24 (Unrelated Evaluation and Management Service by the Same Physician
or Other Qualified Health Care Professional During a Postoperative Period).
27. What is the term for the process of following up on unpaid or underpaid insurance claims?
...Answer... Accounts Receivable (A/R) Follow-up or Claims Follow-up.
28. What does the acronym ABN stand for, and what is its purpose?
...Answer... Advance Beneficiary Notice of Noncoverage. It is a form given to a Medicare patient
to inform them that a service may not be covered by Medicare, and if it is not, they will be
financially responsible for the cost.
29. In HIPAA, what does the "Privacy Rule" protect?
...Answer... It protects all "individually identifiable health information" held or transmitted by a
covered entity, in any form. This is known as Protected Health Information (PHI).
