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NHA Billing and Coding Practice Test Questions, Exams of Nursing

A.T. Still University of Health Sciences (ATSU)Nursing

A practice test for billing and coding, covering essential topics such as claim submission, coding guidelines, and regulatory compliance. It includes multiple-choice questions designed to assess knowledge and skills in medical billing and coding practices, making it a valuable resource for students and professionals preparing for certification exams. The test covers areas like cpt coding, icd-10-cm, hipaa regulations, and claims processing, offering a comprehensive review of key concepts. It also addresses topics such as modifiers, remittance advice, and workers' compensation, providing a well-rounded assessment of billing and coding expertise. This practice test is designed to help users identify areas for improvement and reinforce their understanding of industry standards and best practices.

Typology: Exams

2025/2026

Available from 12/07/2025

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NHA Billing and Coding Practice Test
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?
a. State Insurance Commissioner's office
1. Which of the following is an example of a diagnostic category code?
a. I10
1. The star symbol in the CPT coding manual is used to indicate which of the
following?
a. Telemedicine
1. Which of the following is an advantage of electronic claim submission?
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?
a. When the patient contacts the provider's office and schedules an appointment
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NHA Billing and Coding Practice Test

  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? a. State Insurance Commissioner's office
  2. Which of the following is an example of a diagnostic category code? a. I
  3. The star symbol in the CPT coding manual is used to indicate which of the following? a. Telemedicine
  4. Which of the following is an advantage of electronic claim submission? a. Claims are expedited
  5. When should a billing and coding specialist initiate the collection of the information needed to process a patient's insurance claim form? 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? a. Splinting of the fourth digit on the left foot
  2. 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? a. Wounds should be grouped by anatomic site and coded in order of complexity
  3. Which of the following terms describe the removal of the eye, adnexa, and bony structure? a. Exenteration
  4. 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? a. Suspended
  5. For which of the following reasons should a claim be resubmitted? a. The claim requires an attachment to support medical necessity
  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? a. Temporary disability
  2. Which of the following information is required on a patient account required? a. Name and address of guarantor
  3. A billing and coding specialist is reviewing a delinquent claim. Which of the following actions should the specialist take first? a. Verify the age of the account
  4. 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? a. G51.
  5. 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?
  1. 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? a. Resubmit an updated claim
  2. 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? a. The claim indicated an incorrect place of service
  3. 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? a. Dates of coverage
  4. Which of the following is the purpose of an internal review in a provider's office? a. To verify that the medical records and the billing record match
  5. A claim is submitted with a transposed insurance member ID number and returned to the provider. Which of the following describes the status that will be assigned to the claim by the third-party payer?
  1. An explanation of benefits states the amount billed was $60, and the patient is required to pay a $20 copayment. Which of the following describes the insurance check amount to be posted? $
  2. A billing and coding specialist is reviewing a remittance advice and encounters a denial of payment for a CPT code 44950 (appendectomy). The specialist discovers the ICD-10-CM code assigned to the claim was J32.1 (chronic frontal sinusitis). Which of the following is the reason for this claim denial? a. Incorrectly linked codes were reported on the claim
  3. A billing and coding specialist receives a denial for payment from TRICARE for services provided in the emergency department while a provider was on call. The provider is not a participating TRICARE provider. Which of the following actions must the specialist take to process an appeal for payment? a. Contact the patient for assistance
  4. Which of the following is the third state of a claim's life cycle? a. Adjudication
  5. For which of the following reasons should a billing and coding specialist follow the guidelines in the CPT manual?

a. The guidelines define items that are necessary to accurately code

  1. 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? a. CMS-1500 claim form
  2. Which of the following is the provisions of health insurance policies that specifics which coverage is primary or secondary? a. Coordination of benefits
  3. 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?
  1. Medigap coverage is offered to Medicare beneficiaries by which of the following? a. Private third-party payers
  2. Which of the following statement is true regarding the release of patient information? a. Patient access to psychotherapy notes is restricted
  1. 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? $
  2. 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? a. Notify the patient between 3 and 10 days prior to depositing each check on the indicated dated
  3. A patient has a resection of the intestines with a anastomosis through the abdominal wall. Which of the following is a type of anastomosis? a. Colostomy
  4. 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? a. Identification
  1. Which of the following is a part of a provider's practice compliance program? a. Internal monitoring and auditing
  2. 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? a. Medical unlikely edits
  3. Which of the following is the purpose of running an insurance aging report each month? a. To determine which claims are outstanding from third-party payers
  4. Unlisted codes can be found in which of the following locations in the CPT manual? a. The guidelines prior to each section
  5. Which of the following parts of Medicare is managed by probated third-party payers that have been approved by Medicare? a. Medicare part C
  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? a. 49585
  2. A provider's office receives a subpoena requesting medical documentation from a patient's medical record. After confirming the correct authorization, which of the following actions should a billing and coding specialist take? a. Send the medical information pertaining to the dates of services requested
  3. When reviewing an established patient's insurance card, a billing and coding specialist notices minor changes from the existing card on file. Which of the following action should the specialist take? a. Photocopy both side of the new card
  4. A billing and coding specialist is reviewing an encounter note that indicates a biopsy was performed. This requires which of the following additional details to fully code this procedure? a. Benign vs. malignant status
  5. 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? a. 99213
  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? a. Establish coordination of benefits
  2. Which of the following actions showing a billing and coding specialist take to assign a diagnosis code to the highest level of specificity? a. Apply characters four through seven to the claim
  3. 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?
  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? a. 99204
  2. A billing and coding specialist is submitting a claim for a school-age child who was brought to the clinic by the maternal grandmother. The child's parents are
  1. Which of the following symbols indicate an add-on code in the CPT manual? a. Plus sign
  2. Which of the following is an example of a violation of an audit of adult patient's confidentiality? a. Patient information was disclosed to the patient's parents without consent
  3. HIPAA transaction standards apply to which of the following entities? a. Health care clear houses
  4. 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? $
  5. 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? a. Retrospective review
  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? a. The payer should send reimbursement directly to the provider with the exception of copays and deductibles
  2. Which of the following links the ICD-10-CM and CPT codes for claims processing? a. Diagnosis pointer
  3. 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? a. Send a copy of the operative report with the claim
  4. 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? a. Send a copy of the operative report with the claim
  5. 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? $
  1. Which of the following are qualifying circumstances in the anesthesia section of the CPT manual? a. Add-on codes
  2. 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? a. Excisional procedure
  3. 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? a. The parent whose insurance policy has been active the longest will be the primary insurer
  4. When a patient has a condition that is both acute and chronic, how should it be coded? a. Code both the acute and chronic conditions, sequencing the acute condition first
  5. Outstanding patient balances will appear on which of the following?

a. Account receivable

  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? a. Notify Medicare about the overpayment within 60 days.
  2. Which of the following is a federal government health insurance program? a. TRICARE
  3. Which of the following is used by Medicare to determine if an item or service is covered? a. National Coverage Determination (NCD)
  4. In an outpatient setting, which of the following terms is used as a financial report of all services provided to patients? a. Patient account record
  5. A billing and coding specialist is training a new employee on a claim for a consultation. The new employee asks, "what is a consultation?" Which of the following responses should the specialist make? a. "it's when a provider requests medical advice from a specialist."