NHA MEDICAL BILLING AND CODING
Final Practice Test 2025 Questions with
100% Correct Answers Graded A+
Which of the following is a key protection standard of the
HIPAA Privacy Rule that requires covered entities and
business associates to limit the use or release of protected
health information (PHI)?
Disclosure
A billing and coding specialist is preparing a claim that
includes a code for a miscellaneous supply. Which of the
following actions should the specialist take to ensure the
claim will be paid the first time it is submitted?
Add supplemental documentation with the claim.
Which of the following describes the status of a claim that is
in process and does not include required preauthorization
for a service?
denied
A third-party payer requests a patient's information related to
a claim. A billing and coding specialist should ensure that
which of the following is included in the patient's file before
providing the information?
signed release of information form
Coding manuals use which of the following conventions?
Icons
A billing and coding specialist is using an accounts
receivable aging report to determine which accounts should
be sent to collections. According to best practices, which of
the following accounts should the specialist send to
collections?
An account that has a balance of $600 and is 135 days old
,Which of the following CPT® codes should a billing and
coding specialist use to indicate a total prostate-specific
antigen (PSA) test?
84153 Prostate specific antigen (PSA); Total
Which of the following is the purpose of a claims
clearinghouse?
To identify errors that will prevent a claim from being paid
Which of the following describes a claim that is 120 days
old?
Delinquent
Which of the following government agencies is responsible
for combating fraud and abuse in health insurance and
health care delivery?
Office of Inspector General (OIG)
Which of the following plans requires providers to adhere to
managed care provisions?
Health maintenance organization (HMO) plan
This is included in the ICD-10-CM code set.
Spiral fracture
What code set is used to code diseases, injuries,
impairments, and other health-related problems?
ICD-10-CM codes
An internal retrospective billing account audit prevents fraud
and abuse by reviewing and comparing completed claim
forms with which of the following?
Documentation of compliance plans
Which type of insurance do healthcare professionals
purchase to protect themselves from liability relating to
claims arising from patient treatments?
Medical malpractice
A new patient is seen in the office for frequent urination and
excessive thirst. The provider performs a detailed history
and examination. What coding manual should a billing and
coding specialist reference to determine the Evaluation and
Management (E/M) level of care for this visit?
, CPT
A billing and coding specialist should consider what when
determining an Evaluation and Management (E/M) code?
Place of service
A billing and coding specialist is preparing a claim for a
patient who had an Evaluation and Management (E/M) visit
for abdominal pain that resulted in the decision to remove
the appendix immediately. What modifier should the
specialist use for this claim?
-57
A patient who has a past due balance requests their records
be sent to another provider. What actions should the billing
and coding specialist take with regard to the records
request?
Begin collection action on the balance due.
After a third-party payer validates a claim, what takes place
next?
Claim adjudication
How many days after receipt of an initial demand letter from
a Medicare administrative contractor (MAC) does a provider
have to return an overpayment of $25 or more without
accruing interest?
30 days
A billing and coding specialist is conducting an internal audit
to analyze reimbursement for a provider practice. What
should the specialist understand is the basis for
reimbursement?
Relative value units (RVUs)
A billing and coding specialist is preparing to submit a claim
for a service that requires preauthorization. Preauthorization
must be requested by ___?
Treating provider
Which of the following can be performed when billing
procedural codes?
Final Practice Test 2025 Questions with
100% Correct Answers Graded A+
Which of the following is a key protection standard of the
HIPAA Privacy Rule that requires covered entities and
business associates to limit the use or release of protected
health information (PHI)?
Disclosure
A billing and coding specialist is preparing a claim that
includes a code for a miscellaneous supply. Which of the
following actions should the specialist take to ensure the
claim will be paid the first time it is submitted?
Add supplemental documentation with the claim.
Which of the following describes the status of a claim that is
in process and does not include required preauthorization
for a service?
denied
A third-party payer requests a patient's information related to
a claim. A billing and coding specialist should ensure that
which of the following is included in the patient's file before
providing the information?
signed release of information form
Coding manuals use which of the following conventions?
Icons
A billing and coding specialist is using an accounts
receivable aging report to determine which accounts should
be sent to collections. According to best practices, which of
the following accounts should the specialist send to
collections?
An account that has a balance of $600 and is 135 days old
,Which of the following CPT® codes should a billing and
coding specialist use to indicate a total prostate-specific
antigen (PSA) test?
84153 Prostate specific antigen (PSA); Total
Which of the following is the purpose of a claims
clearinghouse?
To identify errors that will prevent a claim from being paid
Which of the following describes a claim that is 120 days
old?
Delinquent
Which of the following government agencies is responsible
for combating fraud and abuse in health insurance and
health care delivery?
Office of Inspector General (OIG)
Which of the following plans requires providers to adhere to
managed care provisions?
Health maintenance organization (HMO) plan
This is included in the ICD-10-CM code set.
Spiral fracture
What code set is used to code diseases, injuries,
impairments, and other health-related problems?
ICD-10-CM codes
An internal retrospective billing account audit prevents fraud
and abuse by reviewing and comparing completed claim
forms with which of the following?
Documentation of compliance plans
Which type of insurance do healthcare professionals
purchase to protect themselves from liability relating to
claims arising from patient treatments?
Medical malpractice
A new patient is seen in the office for frequent urination and
excessive thirst. The provider performs a detailed history
and examination. What coding manual should a billing and
coding specialist reference to determine the Evaluation and
Management (E/M) level of care for this visit?
, CPT
A billing and coding specialist should consider what when
determining an Evaluation and Management (E/M) code?
Place of service
A billing and coding specialist is preparing a claim for a
patient who had an Evaluation and Management (E/M) visit
for abdominal pain that resulted in the decision to remove
the appendix immediately. What modifier should the
specialist use for this claim?
-57
A patient who has a past due balance requests their records
be sent to another provider. What actions should the billing
and coding specialist take with regard to the records
request?
Begin collection action on the balance due.
After a third-party payer validates a claim, what takes place
next?
Claim adjudication
How many days after receipt of an initial demand letter from
a Medicare administrative contractor (MAC) does a provider
have to return an overpayment of $25 or more without
accruing interest?
30 days
A billing and coding specialist is conducting an internal audit
to analyze reimbursement for a provider practice. What
should the specialist understand is the basis for
reimbursement?
Relative value units (RVUs)
A billing and coding specialist is preparing to submit a claim
for a service that requires preauthorization. Preauthorization
must be requested by ___?
Treating provider
Which of the following can be performed when billing
procedural codes?
