NHA MEDICAL CODING AND BILLING FINAL
PAPER TEST BANK EXAM Q&A 2026 100%
CORRECT.
⫸ When coding for outpatient and professional services and
procedures, a billing and coding specialist must sequence the
diagnosis codes according to ICD-10-CM guidelines. Which of the
following describes the first listed diagnosis code on a claim?
Answer: Primary diagnosis
⫸ Which of the following terms describes the amount the patient
must pay for a service when they have an insurance plan benefit that
pays 70% of the allowed amount and the patient is responsible for
30% of the allowed amount? Answer: Coinsurance
⫸ A billing and coding specialist is contacted by a patient who
requests a copy of the remittance advice for a recently adjudicated
claim. Which of the following actions should the specialist take?
Answer: Remove all information other than what pertains to the
patient.
⫸ A billing and coding specialist is billing or services provided by an
assistant surgeon. Which of the following modifiers should the
specialist use? Answer: -80 (the specialist should use modifier -80 to
indicate services provided by an assistant surgeon)
,⫸ A billing and coding specialist is reviewing a claim edit report and
identifies a rejection for missing patient demographic information.
Which of the following missing pieces of patient demographic
information would cause a rejection from the clearinghouse? Answer:
Date of birth
⫸ HCPCS codes are used in which of the following health care
settings? Answer: Physician clinics
⫸ Which of the following statements is true when determining
patient financial responsibility by reviewing the remittance advice?
Answer: Any coinsurance, copayments, or deductible should be
collected from the patient.
⫸ Which of the following should be included on a claim form that is
sent from a specialist to a managed healthcare organization? Answer:
The referring provider's national provider identifier (NPI)
⫸ A billing and coding specialist is analyzing the health of a
practice's revenue cycle using an aging report. Which of the following
categories of the report should contain the lowest percentage of
accounts receivable? Answer: Greater than 120 days
⫸ Which of the following is an electronic form that is used to post
reimbursements? Answer: Electronic remittance advice (ERA)
⫸ A billing and coding specialist is collecting demographic
information for a patient who lives in Hawaii and is an active duty
, service member. The specialist should identify that the insured has
which of the following types of insurance? Answer: TRICARE
⫸ Which of the following positions is required in a provider's office
to comply with HIPAA regulations? Answer: Privacy officer
⫸ A patients portion of the bill should be discussed with the patient
before a procedure is performed for which of the following reasons?
Answer: To ensure the patient understands how much they are
responsible to pay
⫸ A patient is covered by Medicare through managed care. Which of
the following parts of Medicare includes this coverage? Answer: part
C
⫸ A billing and coding specialist is posting payments from an
explanation of benefits (EOB). Which of the following equations
determines how patient responsibility is calculated? Answer: Charged
amount - payment amount - adjustment amount = patient
responsibility
⫸ A billing and coding specialist is submitting an electronic claim for
a procedure with modifier -22 for increased procedural services.
Which of the following actions should the specialist take? Answer:
Include an attachment to the claim
PAPER TEST BANK EXAM Q&A 2026 100%
CORRECT.
⫸ When coding for outpatient and professional services and
procedures, a billing and coding specialist must sequence the
diagnosis codes according to ICD-10-CM guidelines. Which of the
following describes the first listed diagnosis code on a claim?
Answer: Primary diagnosis
⫸ Which of the following terms describes the amount the patient
must pay for a service when they have an insurance plan benefit that
pays 70% of the allowed amount and the patient is responsible for
30% of the allowed amount? Answer: Coinsurance
⫸ A billing and coding specialist is contacted by a patient who
requests a copy of the remittance advice for a recently adjudicated
claim. Which of the following actions should the specialist take?
Answer: Remove all information other than what pertains to the
patient.
⫸ A billing and coding specialist is billing or services provided by an
assistant surgeon. Which of the following modifiers should the
specialist use? Answer: -80 (the specialist should use modifier -80 to
indicate services provided by an assistant surgeon)
,⫸ A billing and coding specialist is reviewing a claim edit report and
identifies a rejection for missing patient demographic information.
Which of the following missing pieces of patient demographic
information would cause a rejection from the clearinghouse? Answer:
Date of birth
⫸ HCPCS codes are used in which of the following health care
settings? Answer: Physician clinics
⫸ Which of the following statements is true when determining
patient financial responsibility by reviewing the remittance advice?
Answer: Any coinsurance, copayments, or deductible should be
collected from the patient.
⫸ Which of the following should be included on a claim form that is
sent from a specialist to a managed healthcare organization? Answer:
The referring provider's national provider identifier (NPI)
⫸ A billing and coding specialist is analyzing the health of a
practice's revenue cycle using an aging report. Which of the following
categories of the report should contain the lowest percentage of
accounts receivable? Answer: Greater than 120 days
⫸ Which of the following is an electronic form that is used to post
reimbursements? Answer: Electronic remittance advice (ERA)
⫸ A billing and coding specialist is collecting demographic
information for a patient who lives in Hawaii and is an active duty
, service member. The specialist should identify that the insured has
which of the following types of insurance? Answer: TRICARE
⫸ Which of the following positions is required in a provider's office
to comply with HIPAA regulations? Answer: Privacy officer
⫸ A patients portion of the bill should be discussed with the patient
before a procedure is performed for which of the following reasons?
Answer: To ensure the patient understands how much they are
responsible to pay
⫸ A patient is covered by Medicare through managed care. Which of
the following parts of Medicare includes this coverage? Answer: part
C
⫸ A billing and coding specialist is posting payments from an
explanation of benefits (EOB). Which of the following equations
determines how patient responsibility is calculated? Answer: Charged
amount - payment amount - adjustment amount = patient
responsibility
⫸ A billing and coding specialist is submitting an electronic claim for
a procedure with modifier -22 for increased procedural services.
Which of the following actions should the specialist take? Answer:
Include an attachment to the claim
