NHA BILLING AND CODING PRACTICE TEST EXAM QUESTIONS
AND ANSWERS
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? - CORRECT ANSWER✅✅a. State Insurance Commissioner's office
1. Which of the following is an example of a diagnostic category code? - CORRECT ANSWER✅✅a. I10
1. The star symbol in the CPT coding manual is used to indicate which of the following? - CORRECT
ANSWER✅✅a. Telemedicine
1. Which of the following is an advantage of electronic claim submission? - CORRECT ANSWER✅✅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? - CORRECT ANSWER✅✅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? - CORRECT ANSWER✅✅a. Splinting of the fourth digit on the
left foot
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? - CORRECT ANSWER✅✅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? -
CORRECT ANSWER✅✅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? - CORRECT ANSWER✅✅a. Suspended
1. For which of the following reasons should a claim be resubmitted? - CORRECT ANSWER✅✅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? - CORRECT ANSWER✅✅a. Outstanding balances
organized by date
1. Which of the following pieces of guarantor information is required when establishing a patient's
financial record? - CORRECT ANSWER✅✅a. Phone number
1. Which of the following actions by a billing and coding specialist ensures a patient's health information
is protected? - CORRECT ANSWER✅✅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? - CORRECT ANSWER✅✅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? - CORRECT
ANSWER✅✅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? - CORRECT ANSWER✅✅a. Temporary disability
1. Which of the following information is required on a patient account required? - CORRECT
ANSWER✅✅a. Name and address of guarantor
AND ANSWERS
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? - CORRECT ANSWER✅✅a. State Insurance Commissioner's office
1. Which of the following is an example of a diagnostic category code? - CORRECT ANSWER✅✅a. I10
1. The star symbol in the CPT coding manual is used to indicate which of the following? - CORRECT
ANSWER✅✅a. Telemedicine
1. Which of the following is an advantage of electronic claim submission? - CORRECT ANSWER✅✅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? - CORRECT ANSWER✅✅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? - CORRECT ANSWER✅✅a. Splinting of the fourth digit on the
left foot
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? - CORRECT ANSWER✅✅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? -
CORRECT ANSWER✅✅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? - CORRECT ANSWER✅✅a. Suspended
1. For which of the following reasons should a claim be resubmitted? - CORRECT ANSWER✅✅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? - CORRECT ANSWER✅✅a. Outstanding balances
organized by date
1. Which of the following pieces of guarantor information is required when establishing a patient's
financial record? - CORRECT ANSWER✅✅a. Phone number
1. Which of the following actions by a billing and coding specialist ensures a patient's health information
is protected? - CORRECT ANSWER✅✅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? - CORRECT ANSWER✅✅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? - CORRECT
ANSWER✅✅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? - CORRECT ANSWER✅✅a. Temporary disability
1. Which of the following information is required on a patient account required? - CORRECT
ANSWER✅✅a. Name and address of guarantor
