NHA BILLING AND CODING SPECIALIST
110+ (2026 A+ Graded) Exam-Style Questions | Verified Solutions |
Complete Answer Key
100% Guarantee Pass
📋 DOCUMENT OVERVIEW 112 Qs
This document, "NHA Billing and Coding Specialist," covers essential topics in medical billing and coding,
including claim submission and review, remittance advice, demographic information, internal reviews, and
suspicious billing activity. The document provides 112 questions with correct answers and detailed
explanations, serving as a comprehensive review resource for exam preparation . Students can utilize
this document to study and understand key concepts, review and reinforce their knowledge, and gain
confidence in their ability to apply billing and coding principles in a healthcare setting.
✓ Verified Answers ✓ Exam Ready ✓ Study Guide
Trusted by thousands of students and professionals worldwide
EXAM QUESTIONS
QUESTION 1
Billing and coding specialist is reviewing a report from the clearinghouse after submitting electronic
claims and notices one claim was rejected due to missing demographic info. which of the following
actions should the specialist take?
CORRECT ANSWER
Resubmit and updated claim.
RATIONALE: The specialist should resubmit the claim with the missing demographic information because submitting the
same claim again with the corrected information is the only way to resolve the rejection and process the claim correctly.
This action addresses the specific issue causing the rejection, ensuring that the claim is accurately and efficiently processed
by the clearinghouse.
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, QUESTION 2
A Billing and coding specialist is reviewing a report from the clearinghouse after submitting electronic
claims and notices that one claim was rejected due to missing demographic info. Which of the following
actions should the specialist take?
CORRECT ANSWER
Resubmit an updated claim
RATIONALE: The specialist should resubmit an updated claim because the rejection was due to missing demographic
information, which can be corrected and resubmitted to the clearinghouse. This action addresses the specific issue causing
the rejection, increasing the likelihood of the claim being processed successfully.
QUESTION 3
A billing and coding specialist is reviewing a remittance advice from medicare and notices that the
amount paid for a procedure is less that the contracted amount. Which of the following is a potential
reason for the reduced amount of payment?
CORRECT ANSWER
The claim indicated an incorrect place of service.
RATIONALE: The reduced payment is likely due to a discrepancy between the coded procedure and its corresponding place
of service, as indicated by the claim's indication of an incorrect place of service. This discrepancy triggers a payment
adjustment, resulting in the lower payment amount being paid by Medicare.
QUESTION 4
A billing and coding specialist is collecting demographic information from a patient. Which of the
following pieces of information should the specialist expect the Medicaid eligibility verification system
(MEVS) to provide?
CORRECT ANSWER
Dates of Coverage.
RATIONALE: The MEVS is primarily used to verify a patient's Medicaid eligibility, which is crucial for determining the
coverage and payment for healthcare services. Therefore, the specialist should expect the MEVS to provide information
related to the dates of coverage, such as the effective and termination dates of the patient's Medicaid coverage, to ensure
accurate billing and coding.
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, QUESTION 5
Which of the following is the purpose of an internal review in a provider's office?
CORRECT ANSWER
To verify that the medical records and the billing record match.
RATIONALE: An internal review in a provider's office is crucial to ensure the accuracy and consistency of medical records
and billing information, thereby preventing potential discrepancies and financial losses. Verifying that medical records and
billing records match is essential to maintain compliance with regulations, prevent billing errors, and ensure that patients
receive the correct medical care and financial compensation.
QUESTION 6
A claim is submitted with a transposed insurance member ID number and returned to the provider.
Which of the following describes the status that will be assigned to the claim by the 3rd party payer?
CORRECT ANSWER
Invalid
RATIONALE: The transposed insurance member ID number indicates a human error, which does not affect the claim's
validity or eligibility for payment. Therefore, the status assigned by the 3rd party payer is likely to be "Invalid" due to the
error, rather than denying or processing the claim based on its merits.
QUESTION 7
A billing and coding specialist is reviewing a claim for a patient who presented to the provider's office for
an upper respiratory infection. During the encounter, the patient also received the influenza vaccine.
Which modifier should be attached to the (E/M) code?
CORRECT ANSWER
-25
RATIONALE: The modifier -25 is used to indicate that a significant, separately identifiable evaluation and management
(E/M) service was provided, in addition to the administration of a vaccine or immunization. In this scenario, the patient's
upper respiratory infection and influenza vaccine are separate services, making -25 the correct modifier to emphasize the
distinct nature of these two services.
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, QUESTION 8
Which of the following is a Valid ICD-10-CM principle?
CORRECT ANSWER
Code signs and symptoms in the absence of a definitive diagnosis.
RATIONALE: This principle emphasizes the importance of documenting all signs and symptoms encountered during a
patient's encounter, even if they do not lead to a definitive diagnosis. By recording these signs and symptoms, healthcare
providers can provide a more comprehensive and accurate account of the patient's condition, facilitating further diagnosis
and treatment.
QUESTION 9
Which of the following entities are required to follow HIPAA rules and regulations?
CORRECT ANSWER
Clearinghouses, health insurance companies, and billing services.
RATIONALE: These entities are required to follow HIPAA rules and regulations because they deal with protected health
information (PHI) and have a business relationship with covered entities, such as healthcare providers and health plans. By
subjecting them to HIPAA's rules, these entities are held accountable for maintaining the confidentiality, integrity, and
availability of PHI.
QUESTION 10
Which of the following information is correct code symbols in CPT manual?
CORRECT ANSWER
A product pending FDA approval is indicated by a lightening bolt symbol.
RATIONALE: The code symbol is correct because the lightening bolt symbol is specifically used in the CPT manual to denote
a product that has received FDA clearance but is still pending a formal FDA approval, indicating its status in a medical
coding context. This usage of the symbol is a standard convention in CPT coding and is essential for accurate and efficient
coding practices.
QUESTION 11
A billing and coding specialist should add modifier -50 to a code when reporting which of the following?
CORRECT ANSWER
A bilateral procedure.
RATIONALE: Modifier -50 is used to indicate a bilateral procedure, which means the billed service was performed on both
sides of the body or on multiple sites, such as both eyes or both knees. This modifier is added to the code to accurately
reflect the service provided and to prevent undercoding, ensuring proper reimbursement for the more comprehensive
treatment.
Trusted by thousands of students and professionals worldwide Page 4 of 37
110+ (2026 A+ Graded) Exam-Style Questions | Verified Solutions |
Complete Answer Key
100% Guarantee Pass
📋 DOCUMENT OVERVIEW 112 Qs
This document, "NHA Billing and Coding Specialist," covers essential topics in medical billing and coding,
including claim submission and review, remittance advice, demographic information, internal reviews, and
suspicious billing activity. The document provides 112 questions with correct answers and detailed
explanations, serving as a comprehensive review resource for exam preparation . Students can utilize
this document to study and understand key concepts, review and reinforce their knowledge, and gain
confidence in their ability to apply billing and coding principles in a healthcare setting.
✓ Verified Answers ✓ Exam Ready ✓ Study Guide
Trusted by thousands of students and professionals worldwide
EXAM QUESTIONS
QUESTION 1
Billing and coding specialist is reviewing a report from the clearinghouse after submitting electronic
claims and notices one claim was rejected due to missing demographic info. which of the following
actions should the specialist take?
CORRECT ANSWER
Resubmit and updated claim.
RATIONALE: The specialist should resubmit the claim with the missing demographic information because submitting the
same claim again with the corrected information is the only way to resolve the rejection and process the claim correctly.
This action addresses the specific issue causing the rejection, ensuring that the claim is accurately and efficiently processed
by the clearinghouse.
Trusted by thousands of students and professionals worldwide Page 1 of 37
, QUESTION 2
A Billing and coding specialist is reviewing a report from the clearinghouse after submitting electronic
claims and notices that one claim was rejected due to missing demographic info. Which of the following
actions should the specialist take?
CORRECT ANSWER
Resubmit an updated claim
RATIONALE: The specialist should resubmit an updated claim because the rejection was due to missing demographic
information, which can be corrected and resubmitted to the clearinghouse. This action addresses the specific issue causing
the rejection, increasing the likelihood of the claim being processed successfully.
QUESTION 3
A billing and coding specialist is reviewing a remittance advice from medicare and notices that the
amount paid for a procedure is less that the contracted amount. Which of the following is a potential
reason for the reduced amount of payment?
CORRECT ANSWER
The claim indicated an incorrect place of service.
RATIONALE: The reduced payment is likely due to a discrepancy between the coded procedure and its corresponding place
of service, as indicated by the claim's indication of an incorrect place of service. This discrepancy triggers a payment
adjustment, resulting in the lower payment amount being paid by Medicare.
QUESTION 4
A billing and coding specialist is collecting demographic information from a patient. Which of the
following pieces of information should the specialist expect the Medicaid eligibility verification system
(MEVS) to provide?
CORRECT ANSWER
Dates of Coverage.
RATIONALE: The MEVS is primarily used to verify a patient's Medicaid eligibility, which is crucial for determining the
coverage and payment for healthcare services. Therefore, the specialist should expect the MEVS to provide information
related to the dates of coverage, such as the effective and termination dates of the patient's Medicaid coverage, to ensure
accurate billing and coding.
Trusted by thousands of students and professionals worldwide Page 2 of 37
, QUESTION 5
Which of the following is the purpose of an internal review in a provider's office?
CORRECT ANSWER
To verify that the medical records and the billing record match.
RATIONALE: An internal review in a provider's office is crucial to ensure the accuracy and consistency of medical records
and billing information, thereby preventing potential discrepancies and financial losses. Verifying that medical records and
billing records match is essential to maintain compliance with regulations, prevent billing errors, and ensure that patients
receive the correct medical care and financial compensation.
QUESTION 6
A claim is submitted with a transposed insurance member ID number and returned to the provider.
Which of the following describes the status that will be assigned to the claim by the 3rd party payer?
CORRECT ANSWER
Invalid
RATIONALE: The transposed insurance member ID number indicates a human error, which does not affect the claim's
validity or eligibility for payment. Therefore, the status assigned by the 3rd party payer is likely to be "Invalid" due to the
error, rather than denying or processing the claim based on its merits.
QUESTION 7
A billing and coding specialist is reviewing a claim for a patient who presented to the provider's office for
an upper respiratory infection. During the encounter, the patient also received the influenza vaccine.
Which modifier should be attached to the (E/M) code?
CORRECT ANSWER
-25
RATIONALE: The modifier -25 is used to indicate that a significant, separately identifiable evaluation and management
(E/M) service was provided, in addition to the administration of a vaccine or immunization. In this scenario, the patient's
upper respiratory infection and influenza vaccine are separate services, making -25 the correct modifier to emphasize the
distinct nature of these two services.
Trusted by thousands of students and professionals worldwide Page 3 of 37
, QUESTION 8
Which of the following is a Valid ICD-10-CM principle?
CORRECT ANSWER
Code signs and symptoms in the absence of a definitive diagnosis.
RATIONALE: This principle emphasizes the importance of documenting all signs and symptoms encountered during a
patient's encounter, even if they do not lead to a definitive diagnosis. By recording these signs and symptoms, healthcare
providers can provide a more comprehensive and accurate account of the patient's condition, facilitating further diagnosis
and treatment.
QUESTION 9
Which of the following entities are required to follow HIPAA rules and regulations?
CORRECT ANSWER
Clearinghouses, health insurance companies, and billing services.
RATIONALE: These entities are required to follow HIPAA rules and regulations because they deal with protected health
information (PHI) and have a business relationship with covered entities, such as healthcare providers and health plans. By
subjecting them to HIPAA's rules, these entities are held accountable for maintaining the confidentiality, integrity, and
availability of PHI.
QUESTION 10
Which of the following information is correct code symbols in CPT manual?
CORRECT ANSWER
A product pending FDA approval is indicated by a lightening bolt symbol.
RATIONALE: The code symbol is correct because the lightening bolt symbol is specifically used in the CPT manual to denote
a product that has received FDA clearance but is still pending a formal FDA approval, indicating its status in a medical
coding context. This usage of the symbol is a standard convention in CPT coding and is essential for accurate and efficient
coding practices.
QUESTION 11
A billing and coding specialist should add modifier -50 to a code when reporting which of the following?
CORRECT ANSWER
A bilateral procedure.
RATIONALE: Modifier -50 is used to indicate a bilateral procedure, which means the billed service was performed on both
sides of the body or on multiple sites, such as both eyes or both knees. This modifier is added to the code to accurately
reflect the service provided and to prevent undercoding, ensuring proper reimbursement for the more comprehensive
treatment.
Trusted by thousands of students and professionals worldwide Page 4 of 37
