NHA Billing and Coding Practice Test: Questions and Answers | Exams Nursing

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NHA Billing and Coding Practice Test Questions and

Answers Graded A

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

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Answers Graded A

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
Which of the following is an example of a diagnostic category code? - ANSWER - a. I
The star symbol in the CPT coding manual is used to indicate which of the following? - ANSWER - a. Telemedicine
Which of the following is an advantage of electronic claim submission? - ANSWER - a. Claims are expedited
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
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
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
2. For which of the following reasons should a claim be resubmitted? - ANSWER - a. The claim requires an attachment to support medical necessity
3. 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
4. Which of the following pieces of guarantor information is required when establishing a patient's financial record? - ANSWER - a. Phone number
5. Which of the following actions by a billing and

Answers Graded A

coding specialist ensures a patient's health information is protected? - ANSWER - a. Using data encryption software on office workstations

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
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
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
Which of the following information is required on a patient account required? - ANSWER - a. Name and address of guarantor
A billing and coding specialist is reviewing a delinquent claim. Which of the following actions should the specialist take first? - ANSWER - a. Verify the age of the account
1. A patient presents to a provider's office with difficulty speaking, facial drooping, and an inability to close their left eye. They are diagnosed with Bell's palsy. A billing and coding specialist should report which of the following ICD- 10 - CM codes? - ANSWER - a. G51.
2. A patient has a breast biopsy with the placement of a clip. After the biopsy is determined to be malignant, the patient elects for a mastectomy during the global period of the biopsy. Which of the following modifiers should a billing and coding specialist use to report the mastectomy? - ANSWER -- 58
3. 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 information. Which of the following actions should the specialist take? - ANSWER - a. Resubmit an updated claim
4. A billing and coding specialist is reviewing a remittance advice from Medicare and notice that the amount paid for a procedure is less than the contracted amount. Which of the following is potential reason for the reduced amount of payment? - ANSWER - a. The claim indicated an incorrect place of service
5. 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? -

Answers Graded A

A billing and coding specialist should identify that which of the following is used to improve this effectively and effectiveness of the health care system as mandated by HIPAA for providers? - ANSWER - a. CMS-1500 claim form
Which of the following is the provisions of health insurance policies that specifics which coverage is primary or secondary? - ANSWER - a. Coordination of benefits
An employer's worker's compensation payer requires blood work for an employee who experienced a work-related injury. Which of the following modifiers should should a billing and coding specialist take? - ANSWER -- 32
Medigap coverage is offered to Medicare beneficiaries by which of the following? - ANSWER - a. Private third-party payers
Which of the following statement is true regarding the release of patient information? - ANSWER - a. Patient access to psychotherapy notes is restricted
Which of the following is true regarding Medicaid eligibility? - ANSWER - a. Patient eligibility is determined at each visit
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? - ANSWER -- 47
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? - ANSWER - a. 99213
1. A billing and coding specialist observes a colleague preform an unethical act. Which of the following actions should the specialist take? - ANSWER - a. Report the incident to a supervisor
2. 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? - ANSWER - a. Coronary artery bypass graft
3. A patient presents to a primary care provider for a closed index finger fracture. The provider is a non-participating provider for a private payer and does not accept assignment of benefits. The provider's charge for service is $135. The third- party payer's usual customary reasonable (UCR) amount is $120 with 20% coinsurance. Which of the following is the patients responsibility? - ANSWER - $
4. 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 patients 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? - ANSWER - a. Notify the patient between 3 and 10 days prior to depositing each check on the indicated dated

Answers Graded A

A patient has a resection of the intestines with a anastomosis through the abdominal wall. Which of the following is a type of anastomosis?

ANSWER - a. Colostomy

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? - ANSWER - a. Identification
Which of the following is a part of a provider's practice compliance program? - ANSWER - a. Internal monitoring and auditing
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? - ANSWER - a. Medical unlikely edits
Which of the following is the purpose of running an insurance aging report each month? - ANSWER - a. To determine which claims are outstanding from third-party payers
Unlisted codes can be found in which of the following locations in the CPT manual? - ANSWER - a. The guidelines prior to each section
Which of the following parts of Medicare is managed by probated third-party payers that have been approved by Medicare? - ANSWER - a. Medicare part C 1. Which of the following provisions ensures that an insured patient's benefits from a third-party do not exceed 100% of allowable medical expenses? - ANSWER - a. Coordination of benefits 1. When a patient signs an Acknowledgment of Notice of Privacy Practice, it indicated which of the following? - ANSWER - a. The patient accepts the policies and procedures regarding how protected health information (PHI) is handled. 1. Which of the following qualifies a patient for eligibility under Medicare as their primary third- party insurance? - ANSWER - a. Individuals who are under 65 and have a disability 1. A patient is upset about a bill they received because their third-party payer denied the claim. Which of the following actions should a billing and coding specialist take? - ANSWER - a. Inform the patient of the reason for the denial 1. Based on CPT integumentary coding guidelines, MOHS micrographic surgery involves the provider filling which of of the following roles? - ANSWER - a. Both the surgeon and the pathologist 1. Which of the following CPT codes should a billing and coding specialist used to bill for a 5- year-old child who had a hernia repair? - ANSWER - a. 49585 1. A provider's office receives a subpoena

Answers Graded A

provider's outpatient services? - ANSWER - a. CMS-1500 claim form

A billing and coding specialist discovers suspicious activity that may be fraudulent in the workplace. Which of the following actions should the specialist take? - ANSWER - a. Call the U.S. Department of Health and Human Services' (DHHS) anonymous hotline.
Z codes are used to identify which of the following? - ANSWER - a. Immunization
Which of the following symbols indicate an add-on code in the CPT manual? - ANSWER - a. Plus sign
Which of the following is an example of a violation of an audit of adult patient's confidentiality? - ANSWER - a. Patient information was disclosed to the patient's parents without consent
HIPAA transaction standards apply to which of the following entities? - ANSWER - a. Health care clear houses
A patient has met a Medicare deductible of $150. The patient's coinsurance is 20%, and the allowed amount is $600. Which of the following is the patient's out- of - pocket expense? - ANSWER - $
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 preform? - ANSWER - a. Retrospective review
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? - ANSWER - a. The payer should send reimbursement directly to the provider with the exception of copays and deductibles
Which of the following links the ICD- 10 - CM and CPT codes for claims processing? - ANSWER - a. Diagnosis pointer
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? - ANSWER - a. Send a copy of the operative report with the claim
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? - ANSWER - a. Send a copy of the operative report with the claim
A provider's office free is $100 and the Medicare Part B allowed amount is $85. Assuming the beneficiary has not met their annual deductible, the patient should be billed for which of the following amounts? - ANSWER - $
A patient who recently received care from an endocrinologist is bring to an infectious disease

Answers Graded A

specialist. Which of the following types of referrals does the patient need from the endocrinologist? - ANSWER - a. Tertiary care referral

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? - ANSWER - F
In which of the following sections of SOAP note does a provider indicate a patient's reported level of pain? - ANSWER - a. Subjective
Which of the following editing systems should a billing and coding specialist reference to determine if a supplies tray used during and materials code should be assigned to report a surgical tray used during an ambulatory procedure? - ANSWER - a. National Correct Coding Initiative (NCCI)
A patient wants to see and endocrinologist for a consultation about their diabetes mellitus, but they must see their primary care provider (PCP) for a referral to an in-network specialist first. Which of the following types of insurance does the patient have? - ANSWER - a. Health maintenance organization (HMO)
Which of the following are qualifying circumstances in the anesthesia section of the CPT manual? - ANSWER - a. Add-on codes
A billing and coding specialist is reviewing the procedure notes from a provider who selected a code indicating an incisional biopsy when the entirety of the patient's lesion was removed. The specialist should verify with the provider that which of the following types of procedures was performed? - ANSWER - a. Excisional procedure
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? - ANSWER - a. The parent whose insurance policy has been active the longest will be the primary insurer
2. When a patient has a condition that is both acute and chronic, how should it be coded? - ANSWER - a. Code both the acute and chronic conditions, sequencing the acute condition first
3. Outstanding patient balances will appear on which of the following? - ANSWER - a. Account receivable
4. 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? - ANSWER - a. Notify Medicare about the overpayment within 60 days.
5. Which of the following is a federal government health insurance program? - ANSWER - a. TRICARE
6. Which of the following is used by Medicare to determine if an item or service is covered? -

NHA Billing and Coding Practice Test: Questions and Answers, Exams of Nursing

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