NHA Billing and Coding Practice Test
Questions With Verified Solutions.
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? - Answer a. State Insurance Commissioner's office
1. Which of the following is an example of a diagnostic category code? - Answer a. I10
1. The star symbol in the CPT coding manual is used to indicate which of the following? - Answer a.
Telemedicine
1. Which of the following is an advantage of electronic claim submission? - Answer a. Claims are
expedited
1. When should a billing and coding specialist initiate the collection of the information needed to process
a patient's insurance claim form? - Answer a. When the patient contacts the provider's office and
schedules an appointment
1. A billing and coding specialist is reviewing modifier use with a new employee. Which of the following
scenarios warrants the use of a modifier? - Answer a. Splinting of the fourth digit on the left foot
1. 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? - Answer a. Wounds should be grouped by
anatomic site and coded in order of complexity
1. Which of the following terms describe the removal of the eye, adnexa, and bony structure? - Answer
a. Exenteration
, 1. 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? - Answer a. Suspended
1. For which of the following reasons should a claim be resubmitted? - Answer a. The claim requires an
attachment to support medical necessity
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? - Answer a. Outstanding balances organized by
date
1. Which of the following pieces of guarantor information is required when establishing a patient's
financial record? - Answer a. Phone number
1. Which of the following actions by a billing and coding specialist ensures a patient's health information
is protected? - Answer a. Using data encryption software on office workstations
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? - Answer a. Medical record documentation
1. A child is brought into a facility by their mother. The child is cover under both parents' insurance
policies. The child's father was born on 10/1/1980 and their mother was born on 10/2/1921. Which of
the following statements is true regarding the primary policy holder for the child? - Answer a. The
father is the primary policy holder because his birthday falls first in the calendar year
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? - Answer a. Temporary disability
1. Which of the following information is required on a patient account required? - Answer a. Name and
address of guarantor
Questions With Verified Solutions.
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? - Answer a. State Insurance Commissioner's office
1. Which of the following is an example of a diagnostic category code? - Answer a. I10
1. The star symbol in the CPT coding manual is used to indicate which of the following? - Answer a.
Telemedicine
1. Which of the following is an advantage of electronic claim submission? - Answer a. Claims are
expedited
1. When should a billing and coding specialist initiate the collection of the information needed to process
a patient's insurance claim form? - Answer a. When the patient contacts the provider's office and
schedules an appointment
1. A billing and coding specialist is reviewing modifier use with a new employee. Which of the following
scenarios warrants the use of a modifier? - Answer a. Splinting of the fourth digit on the left foot
1. 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? - Answer a. Wounds should be grouped by
anatomic site and coded in order of complexity
1. Which of the following terms describe the removal of the eye, adnexa, and bony structure? - Answer
a. Exenteration
, 1. 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? - Answer a. Suspended
1. For which of the following reasons should a claim be resubmitted? - Answer a. The claim requires an
attachment to support medical necessity
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? - Answer a. Outstanding balances organized by
date
1. Which of the following pieces of guarantor information is required when establishing a patient's
financial record? - Answer a. Phone number
1. Which of the following actions by a billing and coding specialist ensures a patient's health information
is protected? - Answer a. Using data encryption software on office workstations
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? - Answer a. Medical record documentation
1. A child is brought into a facility by their mother. The child is cover under both parents' insurance
policies. The child's father was born on 10/1/1980 and their mother was born on 10/2/1921. Which of
the following statements is true regarding the primary policy holder for the child? - Answer a. The
father is the primary policy holder because his birthday falls first in the calendar year
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? - Answer a. Temporary disability
1. Which of the following information is required on a patient account required? - Answer a. Name and
address of guarantor
