NHA MEDICAL BILLING AND CODING
Final Exam Questions with 100% Correct
Answers Top Rated A+ Latest 2025
Which of the following third-party payers is always the payer
of last resort?
Medicaid
Which of the following is a similarity between a health
maintenance organization (HMO) and a preferred provider
organization (PPO)?
Both plans allow patients to be seen out of network at an
increased cost.
Many third-party payers require that a patient pay a set
amount of eligible charges per year before the patient's
health care plan will begin to pay benefits. This refers to
which of the following terms?
Deductible
A billing and coding specialist is preparing a claim for a
procedure that typically takes about 2hr. Due to
complications, it took 4.5 hr to complete the procedure.
Which of the following modifiers should the specialist use?
-22 Increased procedural services
Which of the following coding manuals is used to identify
products, supplies, and services?
HCPCS Level Il
Which of the following can increase the value of a CPT®
code?
Modifiers
A billing and coding specialist should use which of the
following types of category codes to assign a diagnosis to a
patient who is seeking health services but is not sick?
,Z codes - Factors influencing health status and contact with
health services
Which of the following is the process of sending an
insurance claim through a series of edits for final
determination?
Processing
In which of the following circumstances should a billing and
coding specialist submit a claim with an attachment to a
third-party payer?
When a claim contains unlisted procedure codes
Which of the following is an example of electronic claim
submission?
Submitting claims via a secure network
A patient is admitted to a facility with a primary diagnosis of
pneumonia due to Streptococcus pneumoniae. The patient
also has a history of chronic obstructive pulmonary disease
(COPD) and hypertension. During the patient's stay at the
facility, they experience an acute exacerbation of COPD.
Which of the following indicates the correct order in which
the billing and coding specialist should report the ICD-10-CM
codes?
J13, J44.1, I10
Which of the following scenarios requires an attachment to
be submitted with an electronic claim?
Documentation is needed to support proof of eligibility
A billing and coding specialist should identify that which of
the following statements is correct regarding the filing limit
for Medicaid.
The filing limit is 90 days from the date of service.
Which of the following is the goal of revenue cycle
monitoring?
Ensuring financial viability using standards of measurement
Which of the following is the purpose of precertification?
. To verify coverage
, A billing and coding specialist is reviewing a denied claim for
a patient who was diagnosed with an upper respiratory
infection and had a benignlesion removed. The codes listed
on the claim were 99213 and 17000. Which of the following
actions should the specialist take before resubmitting the
claim?
Add modifier -25 to the claim.
Which of the following are used in coding manuals to
support correct code assignment?
conventions
A patient has managed care insurance and has been referred
to a specialist for gastric bypass surgery. Which of the
following is needed to ensure payment?
Preauthorization
A billing and coding specialist is appealing a denial of
reimbursement from a third-party payer who used a
remittance advice remark code that indicated a lower level of
care could have been provided. Which of the following
situations could result in this type of denial?
A patient was hospitalized for a procedure typically performed as
an outpatient.
Which of the following is the type of service code that can
have three to five levels of service and covers office visits,
hospital visits, and consultations?
Evaluation and Management
A patient has an emergency appendectomy while on
vacation. The claim is rejected due to the patient obtaining
services out-of-network. Which of the following information
should be included in the claim appeal?
The patient was out of town during the emergency
A billing and coding specialist is reviewing a patient's
account and notes there is an outstanding balance that is 45
days old after third-party payer reimbursement. Which of the
following actions should the specialist take?
Final Exam Questions with 100% Correct
Answers Top Rated A+ Latest 2025
Which of the following third-party payers is always the payer
of last resort?
Medicaid
Which of the following is a similarity between a health
maintenance organization (HMO) and a preferred provider
organization (PPO)?
Both plans allow patients to be seen out of network at an
increased cost.
Many third-party payers require that a patient pay a set
amount of eligible charges per year before the patient's
health care plan will begin to pay benefits. This refers to
which of the following terms?
Deductible
A billing and coding specialist is preparing a claim for a
procedure that typically takes about 2hr. Due to
complications, it took 4.5 hr to complete the procedure.
Which of the following modifiers should the specialist use?
-22 Increased procedural services
Which of the following coding manuals is used to identify
products, supplies, and services?
HCPCS Level Il
Which of the following can increase the value of a CPT®
code?
Modifiers
A billing and coding specialist should use which of the
following types of category codes to assign a diagnosis to a
patient who is seeking health services but is not sick?
,Z codes - Factors influencing health status and contact with
health services
Which of the following is the process of sending an
insurance claim through a series of edits for final
determination?
Processing
In which of the following circumstances should a billing and
coding specialist submit a claim with an attachment to a
third-party payer?
When a claim contains unlisted procedure codes
Which of the following is an example of electronic claim
submission?
Submitting claims via a secure network
A patient is admitted to a facility with a primary diagnosis of
pneumonia due to Streptococcus pneumoniae. The patient
also has a history of chronic obstructive pulmonary disease
(COPD) and hypertension. During the patient's stay at the
facility, they experience an acute exacerbation of COPD.
Which of the following indicates the correct order in which
the billing and coding specialist should report the ICD-10-CM
codes?
J13, J44.1, I10
Which of the following scenarios requires an attachment to
be submitted with an electronic claim?
Documentation is needed to support proof of eligibility
A billing and coding specialist should identify that which of
the following statements is correct regarding the filing limit
for Medicaid.
The filing limit is 90 days from the date of service.
Which of the following is the goal of revenue cycle
monitoring?
Ensuring financial viability using standards of measurement
Which of the following is the purpose of precertification?
. To verify coverage
, A billing and coding specialist is reviewing a denied claim for
a patient who was diagnosed with an upper respiratory
infection and had a benignlesion removed. The codes listed
on the claim were 99213 and 17000. Which of the following
actions should the specialist take before resubmitting the
claim?
Add modifier -25 to the claim.
Which of the following are used in coding manuals to
support correct code assignment?
conventions
A patient has managed care insurance and has been referred
to a specialist for gastric bypass surgery. Which of the
following is needed to ensure payment?
Preauthorization
A billing and coding specialist is appealing a denial of
reimbursement from a third-party payer who used a
remittance advice remark code that indicated a lower level of
care could have been provided. Which of the following
situations could result in this type of denial?
A patient was hospitalized for a procedure typically performed as
an outpatient.
Which of the following is the type of service code that can
have three to five levels of service and covers office visits,
hospital visits, and consultations?
Evaluation and Management
A patient has an emergency appendectomy while on
vacation. The claim is rejected due to the patient obtaining
services out-of-network. Which of the following information
should be included in the claim appeal?
The patient was out of town during the emergency
A billing and coding specialist is reviewing a patient's
account and notes there is an outstanding balance that is 45
days old after third-party payer reimbursement. Which of the
following actions should the specialist take?
