NHA BILLING AND CODING PRACTICE
TEST
100+ (Updated for 2026) Exam Prep Pack | A+ Questions & Verified Answers
100% Guarantee Pass
📋 DOCUMENT SUMMARY 101 Qs
This NHA Billing and Coding Practice Test covers specific topics such as payer reimbursement issues,
diagnostic category codes, CPT coding manual symbols, medical unlikely edits, insurance aging reports,
remittance advice forms, and capitated health maintenance organizations (HMOs). The test format features
multiple-choice questions that require students to apply knowledge of billing and coding concepts to
practical scenarios. By completing this practice test, students will learn and practice identifying correct
coding practices, understanding insurance reimbursement processes, and navigating complex billing
scenarios.
✓ Verified Answers ✓ Exam Ready ✓ Study Guide
Trusted by thousands of students and professionals worldwide
EXAM QUESTIONS
QUESTION 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
RATIONALE: The State Insurance Commissioner's office is responsible for overseeing and regulating private payers to
ensure compliance with state laws and regulations, making it the correct entity to contact when reporting a payer's failure
to submit timely reimbursement. This regulatory body has the authority to investigate and enforce actions against payers
that fail to meet their obligations to providers, allowing the specialist to escalate the issue through a proper channel.
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, QUESTION 2
Which of the following is an example of a diagnostic category code?
CORRECT ANSWER
a. I10
RATIONALE: The "I10" code refers to a specific diagnostic category code used in the International Classification of Diseases
(ICD), which is a widely used system for classifying diseases, health conditions, and external causes of injury. This code
falls under the ICD system's structure, indicating that it pertains to a distinct category of diagnostic codes.
QUESTION 3
The star symbol in the CPT coding manual is used to indicate which of the following?
CORRECT ANSWER
a. Telemedicine
RATIONALE: The star symbol in the CPT coding manual is used to indicate a Telemedicine service, which is a crucial
concept for healthcare professionals as it facilitates the remote delivery of medical services, making it a vital component in
modern healthcare practices. This notation is essential for accurate coding and billing, allowing healthcare providers to
efficiently document and process telemedicine services.
QUESTION 4
Which of the following is an advantage of electronic claim submission?
CORRECT ANSWER
a. Claims are expedited
RATIONALE: Electronic claim submission allows claims to be instantly verified and processed, reducing the time it takes for
claims to be approved, which is why "claims are expedited" is a key advantage. This streamlined process minimizes delays
and paperwork errors, making it a more efficient method compared to traditional paper-based claim submission.
QUESTION 5
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
RATIONALE: When the patient contacts the provider's office and schedules an appointment, it is typically the first instance
where the billing and coding specialist becomes aware of the patient's potential need for services and subsequent insurance
claim. At this point, the specialist can begin gathering necessary information to initiate the claims process, ensuring timely
and accurate submission of the claim.
Trusted by thousands of students and professionals worldwide Page 2 of 33
, QUESTION 6
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
RATIONALE: The use of modifier "a" in this scenario is correct because it is applied to procedures that are distinct and
separate from other procedures performed on the same patient, such as splinting a toe in addition to a more serious foot
injury. This modifier is needed to ensure accurate billing and prevent incorrect assignment of the more severe code, as it
indicates that the splinting of the fourth digit on the left foot is a separate procedure from the other treatments.
QUESTION 7
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
RATIONALE: The correct approach is based on the principle of anatomical site grouping, which allows for a more efficient
and accurate representation of a patient's overall condition and treatment. By grouping wounds by anatomic site and coding
them in order of complexity, the billing and coding specialist can ensure that the documentation accurately reflects the
provider's intent and complies with coding guidelines, ultimately facilitating proper reimbursement and minimizing potential
discrepancies.
QUESTION 8
Which of the following terms describe the removal of the eye, adnexa, and bony structure?
CORRECT ANSWER
a. Exenteration
RATIONALE: Exenteration involves the removal of the globe of the eye, its surrounding adnexal structures, and the
associated bony orbit. This procedure typically occurs to treat severe eye cancers or infections, making it the correct term
to describe the removal of the eye, adnexa, and bony structure.
Trusted by thousands of students and professionals worldwide Page 3 of 33
, QUESTION 9
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
RATIONALE: When a claim is initially paid to the wrong provider but the third-party payer intends to reimburse the correct
provider once the error is rectified, the claim is considered "suspended" because the payment is being held in limbo
pending the recoupment of the incorrect payment. This status acknowledges that the claim is still pending, but the initial
payment has already been made, making "suspended" the appropriate term to describe this situation.
QUESTION 10
For which of the following reasons should a claim be resubmitted?
CORRECT ANSWER
a. The claim requires an attachment to support medical necessity
RATIONALE: If a claim does not include an attachment to support medical necessity, it may be denied, leaving the claimant
with the need to resubmit the claim with the required documentation. By resubmitting the claim with the necessary
attachment, the claimant provides sufficient evidence to support their medical expenses, increasing the likelihood of a
successful claim approval.
QUESTION 11
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
RATIONALE: An account receivable aging report is a financial document used to track the age of outstanding customer
invoices, which is essential for identifying overdue payments and managing cash flow effectively. As such, it logically follows
that the report should include outstanding balances organized by date, allowing the specialist to visualize and analyze the
age of each invoice.
Trusted by thousands of students and professionals worldwide Page 4 of 33
TEST
100+ (Updated for 2026) Exam Prep Pack | A+ Questions & Verified Answers
100% Guarantee Pass
📋 DOCUMENT SUMMARY 101 Qs
This NHA Billing and Coding Practice Test covers specific topics such as payer reimbursement issues,
diagnostic category codes, CPT coding manual symbols, medical unlikely edits, insurance aging reports,
remittance advice forms, and capitated health maintenance organizations (HMOs). The test format features
multiple-choice questions that require students to apply knowledge of billing and coding concepts to
practical scenarios. By completing this practice test, students will learn and practice identifying correct
coding practices, understanding insurance reimbursement processes, and navigating complex billing
scenarios.
✓ Verified Answers ✓ Exam Ready ✓ Study Guide
Trusted by thousands of students and professionals worldwide
EXAM QUESTIONS
QUESTION 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
RATIONALE: The State Insurance Commissioner's office is responsible for overseeing and regulating private payers to
ensure compliance with state laws and regulations, making it the correct entity to contact when reporting a payer's failure
to submit timely reimbursement. This regulatory body has the authority to investigate and enforce actions against payers
that fail to meet their obligations to providers, allowing the specialist to escalate the issue through a proper channel.
Trusted by thousands of students and professionals worldwide Page 1 of 33
, QUESTION 2
Which of the following is an example of a diagnostic category code?
CORRECT ANSWER
a. I10
RATIONALE: The "I10" code refers to a specific diagnostic category code used in the International Classification of Diseases
(ICD), which is a widely used system for classifying diseases, health conditions, and external causes of injury. This code
falls under the ICD system's structure, indicating that it pertains to a distinct category of diagnostic codes.
QUESTION 3
The star symbol in the CPT coding manual is used to indicate which of the following?
CORRECT ANSWER
a. Telemedicine
RATIONALE: The star symbol in the CPT coding manual is used to indicate a Telemedicine service, which is a crucial
concept for healthcare professionals as it facilitates the remote delivery of medical services, making it a vital component in
modern healthcare practices. This notation is essential for accurate coding and billing, allowing healthcare providers to
efficiently document and process telemedicine services.
QUESTION 4
Which of the following is an advantage of electronic claim submission?
CORRECT ANSWER
a. Claims are expedited
RATIONALE: Electronic claim submission allows claims to be instantly verified and processed, reducing the time it takes for
claims to be approved, which is why "claims are expedited" is a key advantage. This streamlined process minimizes delays
and paperwork errors, making it a more efficient method compared to traditional paper-based claim submission.
QUESTION 5
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
RATIONALE: When the patient contacts the provider's office and schedules an appointment, it is typically the first instance
where the billing and coding specialist becomes aware of the patient's potential need for services and subsequent insurance
claim. At this point, the specialist can begin gathering necessary information to initiate the claims process, ensuring timely
and accurate submission of the claim.
Trusted by thousands of students and professionals worldwide Page 2 of 33
, QUESTION 6
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
RATIONALE: The use of modifier "a" in this scenario is correct because it is applied to procedures that are distinct and
separate from other procedures performed on the same patient, such as splinting a toe in addition to a more serious foot
injury. This modifier is needed to ensure accurate billing and prevent incorrect assignment of the more severe code, as it
indicates that the splinting of the fourth digit on the left foot is a separate procedure from the other treatments.
QUESTION 7
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
RATIONALE: The correct approach is based on the principle of anatomical site grouping, which allows for a more efficient
and accurate representation of a patient's overall condition and treatment. By grouping wounds by anatomic site and coding
them in order of complexity, the billing and coding specialist can ensure that the documentation accurately reflects the
provider's intent and complies with coding guidelines, ultimately facilitating proper reimbursement and minimizing potential
discrepancies.
QUESTION 8
Which of the following terms describe the removal of the eye, adnexa, and bony structure?
CORRECT ANSWER
a. Exenteration
RATIONALE: Exenteration involves the removal of the globe of the eye, its surrounding adnexal structures, and the
associated bony orbit. This procedure typically occurs to treat severe eye cancers or infections, making it the correct term
to describe the removal of the eye, adnexa, and bony structure.
Trusted by thousands of students and professionals worldwide Page 3 of 33
, QUESTION 9
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
RATIONALE: When a claim is initially paid to the wrong provider but the third-party payer intends to reimburse the correct
provider once the error is rectified, the claim is considered "suspended" because the payment is being held in limbo
pending the recoupment of the incorrect payment. This status acknowledges that the claim is still pending, but the initial
payment has already been made, making "suspended" the appropriate term to describe this situation.
QUESTION 10
For which of the following reasons should a claim be resubmitted?
CORRECT ANSWER
a. The claim requires an attachment to support medical necessity
RATIONALE: If a claim does not include an attachment to support medical necessity, it may be denied, leaving the claimant
with the need to resubmit the claim with the required documentation. By resubmitting the claim with the necessary
attachment, the claimant provides sufficient evidence to support their medical expenses, increasing the likelihood of a
successful claim approval.
QUESTION 11
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
RATIONALE: An account receivable aging report is a financial document used to track the age of outstanding customer
invoices, which is essential for identifying overdue payments and managing cash flow effectively. As such, it logically follows
that the report should include outstanding balances organized by date, allowing the specialist to visualize and analyze the
age of each invoice.
Trusted by thousands of students and professionals worldwide Page 4 of 33
