NHA Billing and Coding Practice Test
1. A billing and coding specialist discovers suspicious activity that may be fraudulent in the
workplace. Which of the following actions should the specialist take? - ANS-a. Call the U.S.
Department of Health and Human Services' (DHHS) anonymous hotline.
\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? - ANS-a. State
Insurance Commissioner's office
\1. A billing and coding specialist identifies a CPT code that is routinely being denied by a
third-party payer. Which of the following types of review should the specialist perform? -
ANS-a. Retrospective review
\1. A billing and coding specialist is arranging a payment plan with a patient who wants to
leave to post dated checks with the office. The patient proposes leaving one check post
dated for 3 months, one for 4 months, and one for 5 months in the future. According to the
federal collection law, which of the following actions should the specialist take? - ANS-a.
Notify the patient between 3 and 10 days prior to depositing each check on the indicated
dated
\1. A billing and coding specialist is assisting a patient who has a capitated health
maintenance organization (HMO) and presents to the office with a sinus infection. The
specialist should identify which of the following statements is true regarding a capitated
HMO? - ANS-a. Payment for the encounter is based on a flat rate
\1. 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? - ANS-a. Dates of coverage
\1. A billing and coding specialist is determining coordination of benefits for a patient who
has health insurance coverage from both parents the patient's father's birthday is May 18,
1982, and their mother's birthday is May 18, 1984. Which of the following statements is
correct for determining coverage? - ANS-a. The parent whose insurance policy has been
active the longest will be the primary insurer
\1. A billing and coding specialist is determining the level of service for an office visit for a
new patient. Which of the following codes represent a detailed history and detailed exam
with moderate decision-making? - ANS-a. 99204
\1. A billing and coding specialist is determining third-party responsibility for a 70-year-old
who has Medicare coverage. The Patient's spouse has insurance with Blue Cross Blue
Shield through their employer. Which of the following actions should the specialist take? -
ANS-a. Establish coordination of benefits
\1. A billing and coding specialist is filing a CMS-1500 claim form for a patient who has a
private insurance. The specialist should recognize that a signature approving assignment of
benefits indicates which of the following? - ANS-a. The payer should send reimbursement
directly to the provider with the exception of copays and deductibles
\1. A billing and coding specialist is posting a Medicare remittance advice and identifies an
overpayment of $15. Which of the following actions should the specialist take? - ANS-a.
Notify Medicare about the overpayment within 60 days.
, \1. A billing and coding specialist is preparing a claim for a appendectomy and reports it with
two units. This claim is then denied. Which of the following coding edits should the specialist
have reviewed prior to submitting the claim? - ANS-a. Medical unlikely edits
\1. A billing and coding specialist is preparing a claim for a patient who had a procedure on
their left index figure. Which of the following modifier indicates the correct digit? - ANS-F1
\1. A billing and coding specialist is preparing a claim for a procedure with a prolonged
operative time that has modifier -22 attached. Which of the following actions should the
specialist take? - ANS-a. Send a copy of the operative report with the claim
\1. A billing and coding specialist is preparing a claim for a procedure with a prolonged
operative time that has modifier -32. Which of the following actions should the specialist
take? - ANS-a. Send a copy of the operative report with the claim
\1. A billing and coding specialist is preparing a claim for a provider. The operative note
indicates the surgeon performed a CABG. The specialist should identify that CABG stands
for which of the following? - ANS-a. Coronary artery bypass graft
\1. A billing and coding specialist is preparing a claim for an established patient who arrived
for an annual exam. During the examination, the provider treated the patient's sinus infection
and prescribed medication for it. Which of the following Evaluation and Management (E/M)
codes requires modifier -52? - ANS-a. 99213
\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? - ANS-a. Outstanding
balances organized by date
\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? - ANS-a. Medical record documentation
\1. A billing and coding specialist is preparing to appeal a partially paid claim due to an
incorrect procedure code. Which of the following steps of the appeal process includes the
review of the claim adjustment reason code? - ANS-a. Identification
\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? - ANS-a. Temporary
disability
\1. 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 of the following modifiers should be attached to the
Evaluation and Management (E/M) code? - ANS--25
\1. A billing and coding specialist is reviewing a claim for an established patient who arrived
at the office with an upper respiratory infection. Which of the following codes should the
specifically use for this encounter? - ANS-a. 99213
\1. A billing and coding specialist is reviewing a claim that was denied for services provided
during the postoperative period. The patient was diagnosed with pneumonia during a
postoperative encounter for a knee joint replacement 2 weeks ago. Which of the following
modifiers should the specialist add the claim prior to resubmitting? - ANS--24
\1. A billing and coding specialist is reviewing a delinquent claim. Which of the following
actions should the specialist take first? - ANS-a. Verify the age of the account
\1. A billing and coding specialist is reviewing a patient's encounter progress note. Which of
the following modifiers indicate the patient received general anesthesia from an surgeon? -
ANS--47
1. A billing and coding specialist discovers suspicious activity that may be fraudulent in the
workplace. Which of the following actions should the specialist take? - ANS-a. Call the U.S.
Department of Health and Human Services' (DHHS) anonymous hotline.
\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? - ANS-a. State
Insurance Commissioner's office
\1. A billing and coding specialist identifies a CPT code that is routinely being denied by a
third-party payer. Which of the following types of review should the specialist perform? -
ANS-a. Retrospective review
\1. A billing and coding specialist is arranging a payment plan with a patient who wants to
leave to post dated checks with the office. The patient proposes leaving one check post
dated for 3 months, one for 4 months, and one for 5 months in the future. According to the
federal collection law, which of the following actions should the specialist take? - ANS-a.
Notify the patient between 3 and 10 days prior to depositing each check on the indicated
dated
\1. A billing and coding specialist is assisting a patient who has a capitated health
maintenance organization (HMO) and presents to the office with a sinus infection. The
specialist should identify which of the following statements is true regarding a capitated
HMO? - ANS-a. Payment for the encounter is based on a flat rate
\1. 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? - ANS-a. Dates of coverage
\1. A billing and coding specialist is determining coordination of benefits for a patient who
has health insurance coverage from both parents the patient's father's birthday is May 18,
1982, and their mother's birthday is May 18, 1984. Which of the following statements is
correct for determining coverage? - ANS-a. The parent whose insurance policy has been
active the longest will be the primary insurer
\1. A billing and coding specialist is determining the level of service for an office visit for a
new patient. Which of the following codes represent a detailed history and detailed exam
with moderate decision-making? - ANS-a. 99204
\1. A billing and coding specialist is determining third-party responsibility for a 70-year-old
who has Medicare coverage. The Patient's spouse has insurance with Blue Cross Blue
Shield through their employer. Which of the following actions should the specialist take? -
ANS-a. Establish coordination of benefits
\1. A billing and coding specialist is filing a CMS-1500 claim form for a patient who has a
private insurance. The specialist should recognize that a signature approving assignment of
benefits indicates which of the following? - ANS-a. The payer should send reimbursement
directly to the provider with the exception of copays and deductibles
\1. A billing and coding specialist is posting a Medicare remittance advice and identifies an
overpayment of $15. Which of the following actions should the specialist take? - ANS-a.
Notify Medicare about the overpayment within 60 days.
, \1. A billing and coding specialist is preparing a claim for a appendectomy and reports it with
two units. This claim is then denied. Which of the following coding edits should the specialist
have reviewed prior to submitting the claim? - ANS-a. Medical unlikely edits
\1. A billing and coding specialist is preparing a claim for a patient who had a procedure on
their left index figure. Which of the following modifier indicates the correct digit? - ANS-F1
\1. A billing and coding specialist is preparing a claim for a procedure with a prolonged
operative time that has modifier -22 attached. Which of the following actions should the
specialist take? - ANS-a. Send a copy of the operative report with the claim
\1. A billing and coding specialist is preparing a claim for a procedure with a prolonged
operative time that has modifier -32. Which of the following actions should the specialist
take? - ANS-a. Send a copy of the operative report with the claim
\1. A billing and coding specialist is preparing a claim for a provider. The operative note
indicates the surgeon performed a CABG. The specialist should identify that CABG stands
for which of the following? - ANS-a. Coronary artery bypass graft
\1. A billing and coding specialist is preparing a claim for an established patient who arrived
for an annual exam. During the examination, the provider treated the patient's sinus infection
and prescribed medication for it. Which of the following Evaluation and Management (E/M)
codes requires modifier -52? - ANS-a. 99213
\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? - ANS-a. Outstanding
balances organized by date
\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? - ANS-a. Medical record documentation
\1. A billing and coding specialist is preparing to appeal a partially paid claim due to an
incorrect procedure code. Which of the following steps of the appeal process includes the
review of the claim adjustment reason code? - ANS-a. Identification
\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? - ANS-a. Temporary
disability
\1. 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 of the following modifiers should be attached to the
Evaluation and Management (E/M) code? - ANS--25
\1. A billing and coding specialist is reviewing a claim for an established patient who arrived
at the office with an upper respiratory infection. Which of the following codes should the
specifically use for this encounter? - ANS-a. 99213
\1. A billing and coding specialist is reviewing a claim that was denied for services provided
during the postoperative period. The patient was diagnosed with pneumonia during a
postoperative encounter for a knee joint replacement 2 weeks ago. Which of the following
modifiers should the specialist add the claim prior to resubmitting? - ANS--24
\1. A billing and coding specialist is reviewing a delinquent claim. Which of the following
actions should the specialist take first? - ANS-a. Verify the age of the account
\1. A billing and coding specialist is reviewing a patient's encounter progress note. Which of
the following modifiers indicate the patient received general anesthesia from an surgeon? -
ANS--47
