NHA BILLING AND CODING SPECIALIST ACTUAL EXAM PREP 2026 ALL QUESTIONS AND CORRECT DETAILED ANSWERS ALREADY A GRADED WITH EXPERT FEEDBACK|NEW AND REVISED

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NHA BILLING AND CODING SPECIALIST
ACTUAL EXAM PREP 2026 ALL QUESTIONS
AND CORRECT DETAILED ANSWERS
ALREADY A GRADED WITH EXPERT
FEEDBACK|NEW AND REVISED




1. Which code set is used to report diagnoses for outpatient physician
encounters in the United States?
A. CPT
B. HCPCS Level II
C. ICD-10-CM
D. ICD-10-PCS
ICD-10-CM is the official diagnosis classification for morbidity
reporting in U.S. outpatient and inpatient settings.
2. What is the primary purpose of the CMS-1500 claim form?
A. Hospital inpatient billing only
B. Dental claims processing
C. Employer payroll reporting
D. Professional/physician services claims submission
The CMS-1500 is the standard paper claim form used to bill
physician and other professional services to payers.
3. Which of the following modifiers indicates a bilateral procedure?
A. -25
B. -50
C. -59
D. -76

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Modifier -50 denotes a bilateral procedure performed during the
same operative session.
4. When is it appropriate to append CPT modifier -25?
A. For separate unrelated surgical procedures on different days
B. For coding two providers at the same encounter
C. When a significant, separately identifiable E/M service is
provided on the same day as a procedure
D. To indicate unlisted services
Modifier -25 is used to report a significant, separately identifiable
evaluation and management service on the same day as a minor
procedure.
5. Which resource contains official, annual coding guidelines for
ICD-10-CM?
A. AMA CPT manual only
B. HCPCS Level II index
C. ICD-10-CM Official Guidelines (CMS/CDC/AHA/AHIMA)
D. Local payer websites exclusively
The ICD-10-CM Official Guidelines are published annually by
CMS/CDC and professional organizations and must be followed
when assigning diagnosis codes. (CMS)
6. A claim is denied for “patient not covered.” The correct first step
in resolution is to:
A. Resubmit immediately with the same data
B. Verify patient eligibility and coverage dates with the payer
C. File an appeal without verification
D. Bill the patient regardless of coverage
Eligibility verification identifies whether the denial was due to
coverage lapse or incorrect patient information before further
action.
7. Which coding system is primarily used to report inpatient
procedural procedures in U.S. hospital settings?
A. CPT
B. ICD-10-PCS
C. HCPCS Level II
D. SNOMED CT

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ICD-10-PCS is used for reporting inpatient procedures in U.S.
acute care hospitals.
8. What is the correct action when encountering PHI in an unsecured
email?
A. Forward without encryption to a colleague for convenience
B. Post the information to an internal bulletin board
C. Delete the email without reporting
D. Notify appropriate privacy/security officer and follow
organizational breach policy
PHI in unsecured channels may constitute a breach and requires
reporting per HIPAA policies.
9. Which term describes the amount a patient must pay before
insurance begins to pay?
A. Coinsurance
B. Copayment
C. Deductible
D. Allowed amount
Deductible is the amount a patient pays out-of-pocket before the
plan pays covered services.
10. When selecting ICD-10-CM codes, the coder must:
A. Choose the most general code available
B. Ignore laterality and specificity
C. Report the most specific code supported by the
documentation
D. Always use unspecified codes to speed processing
ICD-10-CM requires the most specific code that accurately
reflects the documented diagnosis and clinical scenario.
11. Which of the following is a valid reason to use an unlisted
CPT code (●) rather than a specific code?
A. To inflate reimbursement for common services
B. When a payor requires a code for every charge
C. When no specific CPT code exists for the procedure
performed
D. As a placeholder for future billing
Unlisted codes are used when procedures are unique or not

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described by existing CPT codes and require supporting
documentation.
12. A patient receives service in a physician’s office and pays a
$25 copay at registration. On the claim, the coder should:
A. Report the full charge and never note the copay
B. Deduct the copay from the billed amount only if requested by
the payer
C. Include the full charge and report the patient payment in
the appropriate field on the claim
D. Bill net of copay and leave patient responsibility blank
Claims should show the full charge; patient payments are
reported in claim fields to reflect accurate accounting.
13. What is the main purpose of a remittance advice (RA) or
explanation of benefits (EOB)?
A. To authorize future procedures only
B. To act as a legal contract between employer and insurer
C. To explain how the claim was processed, payments made,
denials, and patient responsibility
D. To replace medical records documentation
The RA/EOB provides payment details and reasons for
denials/adjustments used for reconciliation and appeals.
14. Which HIPAA rule covers the security of electronic
protected health information (ePHI)?
A. Privacy Rule only
B. Security Rule
C. Breach Notification Rule only
D. Transactions & Code Sets Rule only
The Security Rule sets standards to protect ePHI through
administrative, physical, and technical safeguards under HIPAA.
15. When is a signed Advance Beneficiary Notice (ABN)
required?
A. For elective cosmetic procedures only
B. When Medicare is expected to deny payment for a service
but the service will be provided and the beneficiary may be
held financially responsible