NHA Practice Exam

NHA MEDICAL BILLING & CODING

100-QUESTION PRACTICE EXAM

Instructions: Choose the best answer for each question. Try to complete all 100 questions before checking the answer key.

QUESTIONS 1–25: MEDICAL TERMINOLOGY & ANATOMY

1. What does the suffix “-itis” indicate?

A. Surgical removal
B. Inflammation
C. Pain
D. Enlargement

2. What does “bradycardia” mean?

A. Rapid heart rate
B. Irregular heart rhythm
C. Slow heart rate
D. High blood pressure

3. Which body system includes the heart and blood vessels?

A. Respiratory
B. Cardiovascular
C. Endocrine
D. Lymphatic

4. Which plane divides the body into anterior and posterior portions?

A. Sagittal
B. Transverse
C. Frontal/coronal
D. Midsagittal

5. Which term means “toward the midline of the body”?

A. Lateral
B. Distal
C. Medial
D. Proximal

6. Which term means “closer to the point of attachment”?

A. Distal
B. Proximal
C. Inferior
D. Deep

7. What does the suffix “-ectomy” mean?

A. Surgical removal
B. Surgical repair
C. Incision
D. Visual examination

8. Which organ is primarily responsible for filtering blood and producing urine?

A. Liver
B. Pancreas
C. Kidney
D. Spleen

9. Which system is primarily responsible for gas exchange?

A. Digestive
B. Respiratory
C. Urinary
D. Endocrine

10. Which abbreviation means “nothing by mouth”?

A. PRN
B. NPO
C. BID
D. PO

11. Which abbreviation means “twice daily”?

A. BID
B. TID
C. QID
D. PRN

12. What does “tachy-” mean?

A. Slow
B. Below
C. Fast
D. Around

13. What does “hypo-” generally mean?

A. Excessive
B. Below or deficient
C. Around
D. Within

14. Which body system regulates hormones?

A. Endocrine
B. Musculoskeletal
C. Respiratory
D. Integumentary

15. Which term means “farther from the point of attachment”?

A. Proximal
B. Medial
C. Distal
D. Superior

16. What is physiology?

A. Study of body structures
B. Study of body functions
C. Study of disease coding
D. Study of medications

17. Which organ is primarily responsible for pumping blood?

A. Lung
B. Kidney
C. Heart
D. Liver

18. What does the suffix “-algia” indicate?

A. Inflammation
B. Pain
C. Disease
D. Blood condition

19. Which system includes the brain and spinal cord?

A. Nervous
B. Endocrine
C. Digestive
D. Cardiovascular

20. What does “peri-” mean?

A. Within
B. Under
C. Around
D. Above

21. Which term means “toward the front of the body”?

A. Posterior
B. Anterior
C. Inferior
D. Deep

22. Which organ is part of the digestive system?

A. Stomach
B. Kidney
C. Trachea
D. Bladder

23. What does the suffix “-scopy” generally indicate?

A. Surgical removal
B. Visual examination
C. Inflammation
D. Pain

24. Which body system includes bones, muscles, and joints?

A. Musculoskeletal
B. Respiratory
C. Endocrine
D. Urinary

25. What is pathology?

A. Study of normal body functions
B. Study of body structures
C. Study of disease and abnormal conditions
D. Study of insurance plans

QUESTIONS 26–45: ICD-10-CM, CPT & HCPCS

26. What is ICD-10-CM primarily used to report?

A. Procedures
B. Diagnoses and conditions
C. Insurance payments
D. Medical equipment only

27. What is CPT primarily used to report?

A. Diagnoses
B. Procedures and services
C. Patient demographics
D. Insurance eligibility

28. What is HCPCS Level II commonly used to report?

A. Diagnoses
B. Supplies, equipment, and certain medications/services
C. Only physician visits
D. Only inpatient diagnoses

29. What should a coder do after locating a diagnosis in the ICD-10-CM Alphabetic Index?

A. Submit the claim
B. Verify the code in the Tabular List
C. Choose the first code available
D. Ask the patient to select the code

30. Which ICD-10-CM resource contains inclusion and exclusion notes?

A. Tabular List
B. CMS-1500
C. CPT Index
D. EOB

31. What does an “Excludes1” note generally mean?

A. The two conditions should not be coded together
B. An additional code is required
C. The diagnosis is optional
D. The code is obsolete

32. What does an “Excludes2” note generally mean?

A. The excluded condition may never be coded
B. Both conditions may be coded when appropriate
C. The code must be deleted
D. The diagnosis is always secondary

33. Why is laterality important in ICD-10-CM?

A. It identifies the payer
B. It identifies the provider
C. It identifies the side of the body affected
D. It identifies the patient’s age

34. What is the purpose of a placeholder X?

A. To indicate a rejected claim
B. To allow proper placement of a required 7th character
C. To indicate a diagnosis is uncertain
D. To identify Medicare

35. Which CPT category is used for emerging technologies and procedures?

A. Category I
B. Category II
C. Category III
D. Category IV

36. Which CPT category is generally used for performance measurement?

A. Category I
B. Category II
C. Category III
D. HCPCS

37. Which modifier indicates a significant, separately identifiable E/M service performed on the same day as another procedure?

A. -25
B. -26
C. -59
D. -91

38. Which modifier indicates the professional component?

A. -TC
B. -26
C. -25
D. -52

39. Which modifier indicates the technical component?

A. -26
B. -TC
C. -59
D. -79

40. Which modifier indicates a distinct procedural service?

A. -24
B. -25
C. -51
D. -59

41. Which modifier is used for a reduced service?

A. -52
B. -53
C. -57
D. -91

42. Which modifier is used when a procedure is discontinued?

A. -52
B. -53
C. -59
D. -79

43. What does CPT Category I contain?

A. Established procedures and services
B. Temporary emerging technology codes only
C. Diagnosis codes
D. Revenue codes

44. A coder finds a diagnosis in the documentation but cannot determine the required specificity. What should the coder do?

A. Guess the most specific code
B. Use the documentation-supported code
C. Choose the highest-paying code
D. Ask the patient to choose

45. Which statement is correct?

A. ICD-10-CM describes what procedure was performed
B. CPT describes why the patient received care
C. ICD-10-CM generally describes diagnoses, while CPT reports procedures/services
D. HCPCS Level II replaces ICD-10-CM

QUESTIONS 46–65: BILLING & CLAIMS

46. Which claim form is primarily used for professional services?

A. UB-04
B. CMS-1500
C. ADA claim form
D. MAR

47. Which claim form is primarily used for institutional services?

A. CMS-1500
B. UB-04/CMS-1450
C. NCPDP
D. ADA

48. What does NPI stand for?

A. National Patient Identification
B. National Provider Identifier
C. National Payment Index
D. National Physician Insurance

49. How many digits are in an NPI?

A. 8
B. 9
C. 10
D. 12

50. What is a Place of Service code used to identify?

A. The diagnosis
B. Where the service was performed
C. The patient’s insurance company
D. The provider’s specialty

51. What is POS 11?

A. Hospital inpatient
B. Office
C. Emergency department
D. Home

52. What is POS 21?

A. Hospital inpatient
B. Office
C. Home
D. Laboratory

53. What is POS 22?

A. Hospital outpatient
B. Inpatient hospital
C. Office
D. Nursing facility

54. What is medical necessity?

A. A patient’s ability to pay
B. A service being reasonable and necessary for diagnosis or treatment
C. A provider’s specialty
D. A patient’s insurance premium

55. What is a clean claim?

A. A claim submitted without a patient name
B. A claim containing required information and no processing errors
C. A claim that has been denied
D. A claim submitted only on paper

56. What is a claim scrubber designed to do?

A. Collect patient payments
B. Check claims for errors before submission
C. Determine patient eligibility
D. Process payroll

57. A claim is rejected because the patient’s date of birth was entered incorrectly. What should the biller generally do?

A. Appeal the claim
B. Correct the information and resubmit
C. Bill the patient immediately
D. Delete the claim

58. What is the primary difference between a rejection and denial?

A. Rejections occur after payment
B. Denials occur before submission
C. Rejections prevent processing; denials occur after payer processing
D. There is no difference

59. What is a clearinghouse?

A. A facility that treats patients
B. An intermediary that checks and routes electronic claims
C. A government insurance program
D. A coding manual

60. What does EDI stand for?

A. Electronic Data Interchange
B. Electronic Diagnosis Information
C. Emergency Data Interface
D. Electronic Document Insurance

61. Which electronic transaction is commonly used to submit healthcare claims?

A. 270
B. 271
C. 835
D. 837

62. Which electronic transaction is commonly associated with electronic remittance advice?

A. 835
B. 837
C. 270
D. 276

63. Which transaction is commonly used to request eligibility information?

A. 270
B. 271
C. 835
D. 837

64. Which transaction is commonly used to receive an eligibility response?

A. 270
B. 271
C. 276
D. 277

65. What is the purpose of timely filing requirements?

A. To establish when a provider may hire employees
B. To establish the deadline for submitting claims
C. To establish a patient’s deductible
D. To determine the diagnosis code

QUESTIONS 66–80: INSURANCE & REIMBURSEMENT

66. What is a deductible?

A. A fixed payment for each visit
B. A percentage paid by the patient
C. An amount the patient generally pays before applicable benefits begin paying
D. The insurance premium

67. What is a copayment?

A. A percentage of the allowed amount
B. A fixed dollar amount paid by the patient
C. The provider’s charge
D. A payer adjustment

68. What is coinsurance?

A. A fixed dollar amount
B. A percentage of the applicable allowed amount
C. The monthly premium
D. The deductible

69. What is a premium?

A. Amount paid to maintain insurance coverage
B. Patient’s deductible
C. Provider’s charge
D. Claim adjustment

70. What is an allowed amount?

A. The provider’s original charge
B. The amount recognized under the applicable payer plan for a covered service
C. The patient’s premium
D. The patient’s total bill

71. Which type of plan generally emphasizes a provider network and coordinated care?

A. HMO
B. PPO
C. EPO
D. Medicare Part D

72. Which plan generally offers greater flexibility in choosing providers, including potential out-of-network coverage?

A. HMO
B. PPO
C. Medicaid
D. EPO

73. What does COB stand for?

A. Coordination of Benefits
B. Calculation of Billing
C. Coverage of Benefits
D. Coordination of Billing

74. When a patient has two insurance plans, what does COB help determine?

A. Which diagnosis is correct
B. Which payer is primary and which is secondary
C. Which provider should treat the patient
D. Which CPT code to use

75. What is prior authorization?

A. A patient’s payment
B. Payer approval required before certain services
C. A claim denial
D. A medical record

76. Does prior authorization guarantee payment?

A. Yes, always
B. No
C. Only for Medicare
D. Only for Medicaid

77. Which Medicare part primarily covers inpatient hospital services?

A. Part A
B. Part B
C. Part C
D. Part D

78. Which Medicare part primarily covers physician and outpatient medical services?

A. Part A
B. Part B
C. Part C
D. Part D

79. Which Medicare part provides prescription drug coverage?

A. Part A
B. Part B
C. Part C
D. Part D

80. What is Medicare Part C?

A. Medicaid
B. Medicare Advantage
C. Prescription drug coverage only
D. Hospital insurance only

QUESTIONS 81–100: COMPLIANCE, HIPAA & PRACTICAL BILLING

81. What does HIPAA primarily help protect?

A. Provider salaries
B. Patient health information and privacy
C. Hospital construction
D. Medical equipment

82. What does PHI stand for?

A. Personal Health Insurance
B. Protected Health Information
C. Patient Health Identifier
D. Protected Hospital Information

83. Which is an example of a HIPAA violation?

A. Verifying a patient’s insurance
B. Discussing a patient’s condition with an authorized provider
C. Accessing a patient’s record without a legitimate need
D. Sending a claim to the patient’s insurer

84. What does the HIPAA “minimum necessary” principle generally require?

A. Sharing all available patient information
B. Limiting PHI use or disclosure to what is reasonably necessary for the purpose
C. Destroying all patient records
D. Giving patients unrestricted employee passwords

85. Which ethical principle means “do no harm”?

A. Autonomy
B. Beneficence
C. Nonmaleficence
D. Justice

86. Which ethical principle involves respecting a patient’s right to make decisions?

A. Autonomy
B. Fidelity
C. Justice
D. Veracity

87. What is upcoding?

A. Reporting a lower-level service
B. Reporting a higher-level service than supported by documentation
C. Correcting a claim
D. Posting a payment

88. What is unbundling?

A. Combining unrelated diagnoses
B. Reporting components separately when they should be reported as a bundled service
C. Verifying insurance
D. Submitting an electronic claim

89. Which is an example of healthcare fraud?

A. Correcting a rejected claim
B. Billing for services that were never provided
C. Verifying eligibility
D. Appealing a valid denial

90. What is healthcare abuse?

A. Any accidental typo
B. Practices that may lead to unnecessary costs or improper payment
C. Protecting PHI
D. Submitting clean claims

91. What is an EOB?

A. Explanation of Benefits
B. Electronic Office Billing
C. Examination of Billing
D. Electronic Order Benefit

92. Which statement about an EOB is correct?

A. It is always the patient’s bill
B. It explains how the payer processed a claim
C. It is a medical record
D. It is a CPT manual

93. What is an ERA?

A. Electronic Remittance Advice
B. Electronic Registration Authorization
C. Emergency Reimbursement Account
D. Electronic Record Application

94. What does accounts receivable represent?

A. Money owed to the healthcare organization
B. Money the provider owes employees
C. Insurance premiums
D. Medical records

95. Why are A/R aging reports used?

A. To identify patient diagnoses
B. To organize unpaid balances by age
C. To select CPT codes
D. To assign NPI numbers

96. Which account generally requires the most urgent follow-up?

A. A recently submitted claim with no payment due yet
B. A very old unpaid account approaching payer deadlines
C. A paid claim
D. A claim already resolved

97. A payer denies a claim because required prior authorization was not obtained. What should the biller do FIRST?

A. Immediately bill the patient
B. Review the denial and authorization requirements
C. Delete the patient’s account
D. Change the diagnosis without documentation

98. A provider performed a procedure but the documentation does not support the modifier being used. What should the coder do?

A. Keep the modifier because it increases reimbursement
B. Remove or correct the modifier based on documentation and coding guidelines
C. Add another modifier
D. Ask the patient to approve it

99. A patient calls requesting information about a spouse’s medical claim. What should the biller do before disclosing PHI?

A. Give the information immediately
B. Verify that the caller is authorized to receive the information
C. Provide the entire medical record
D. Ask for the patient’s CPT code

100. Which approach is BEST when coding a medical record?

A. Code the most expensive service
B. Code what is documented and follow official coding guidelines
C. Code what the patient believes occurred
D. Choose codes based only on reimbursement

ANSWER KEY

ANSWERS & EXPLANATIONS

1. B — Inflammation

The suffix “-itis” means inflammation, such as arthritis (inflammation of a joint).

2. C — Slow heart rate

“Brady-” means slow and “-cardia” relates to the heart rate.

3. B — Cardiovascular

The cardiovascular system consists primarily of the heart and blood vessels.

4. C — Frontal/coronal

The frontal plane divides the body into anterior and posterior portions.

5. C — Medial

Medial means toward the body’s midline.

6. B — Proximal

Proximal means closer to the point of attachment.

7. A — Surgical removal

“-ectomy” means surgical removal.

8. C — Kidney

The kidneys filter blood and produce urine.

9. B — Respiratory

The respiratory system is responsible for ventilation and gas exchange.

10. B — NPO

NPO means nothing by mouth.

11. A — BID

BID means twice daily.

12. C — Fast

“Tachy-” means fast or rapid.

13. B — Below or deficient

“Hypo-” generally indicates below normal, low, or deficient.

14. A — Endocrine

The endocrine system produces and regulates hormones.

15. C — Distal

Distal means farther from the point of attachment.

16. B — Study of body functions

Physiology concerns how the body works.

17. C — Heart

The heart pumps blood throughout the body.

18. B — Pain

“-algia” indicates pain.

19. A — Nervous

The brain and spinal cord are major components of the nervous system.

20. C — Around

“Peri-” means around.

21. B — Anterior

Anterior means toward the front of the body.

22. A — Stomach

The stomach is part of the digestive system.

23. B — Visual examination

“-scopy” refers to visual examination.

24. A — Musculoskeletal

The musculoskeletal system includes bones, muscles, joints, and connective tissues.

25. C — Study of disease

Pathology is the study of disease and abnormal conditions.

26. B — Diagnoses and conditions

ICD-10-CM is primarily used to report diagnoses and health conditions.

27. B — Procedures and services

CPT primarily reports procedures and professional services.

28. B — Supplies, equipment, and certain medications/services

HCPCS Level II includes many products, supplies, equipment, medications, ambulance services, and other services.

29. B — Verify in the Tabular List

The Alphabetic Index helps locate a code, but the Tabular List must be reviewed for complete instructions.

30. A — Tabular List

The Tabular List contains code descriptions and important coding instructions.

31. A — Conditions should not be coded together

Excludes1 generally indicates that the two conditions should not be reported together.

32. B — Both may be coded when appropriate

Excludes2 means the excluded condition is not part of the coded condition, but both may be reported when appropriate.

33. C — Side of the body

Laterality identifies right, left, or bilateral when applicable.

34. B — Proper 7th-character placement

An X can serve as a placeholder when required to position a 7th character correctly.

35. C — Category III

Category III CPT codes are temporary codes used for emerging technologies, procedures, and services.

36. B — Category II

Category II codes are optional performance measurement/tracking codes.

37. A — Modifier -25

Modifier -25 identifies a significant, separately identifiable E/M service on the same day as another procedure/service.

38. B — Modifier -26

Modifier -26 identifies the professional component.

39. B — Modifier -TC

Modifier -TC identifies the technical component.

40. D — Modifier -59

Modifier -59 identifies a distinct procedural service when the applicable requirements are met.

41. A — Modifier -52

Modifier -52 indicates reduced services.

42. B — Modifier -53

Modifier -53 is used for a discontinued procedure in applicable circumstances.

43. A — Established procedures/services

Category I contains established CPT procedures and services.

44. B — Use documentation-supported coding

Coders should never guess. Code to the level of specificity supported by documentation and applicable guidelines.

45. C — ICD-10-CM = diagnosis; CPT = procedure/service

This is one of the most important distinctions for the exam.

46. B — CMS-1500

CMS-1500 is primarily used for professional claims.

47. B — UB-04/CMS-1450

UB-04 is primarily used for institutional claims.

48. B — National Provider Identifier

NPI stands for National Provider Identifier.

49. C — 10

An NPI contains 10 digits.

50. B — Where service was performed

Place of Service codes identify the location where healthcare services were provided.

51. B — Office

POS 11 represents an office.

52. A — Hospital inpatient

POS 21 represents inpatient hospital services.

53. A — Hospital outpatient

POS 22 represents hospital outpatient services.

54. B — Reasonable and necessary care

Medical necessity means the service is reasonable and necessary for diagnosis or treatment according to applicable requirements.

55. B — Complete and processable claim

A clean claim contains the required information and can generally be processed without correction.

56. B — Check claims for errors

A claim scrubber identifies potential errors before submission.

57. B — Correct and resubmit

A rejection generally means the claim cannot be processed because of an error. Correct it and resubmit.

58. C — Rejection vs denial

A rejection prevents the claim from being processed. A denial generally occurs after the payer has adjudicated/processed the claim.

59. B — Electronic claim intermediary

A clearinghouse receives, checks, and routes electronic claims.

60. A — Electronic Data Interchange

EDI is the electronic exchange of standardized healthcare information.

61. D — 837

The 837 transaction is used for healthcare claims.

62. A — 835

The 835 transaction is associated with electronic remittance advice.

63. A — 270

The 270 transaction is an eligibility inquiry.

64. B — 271

The 271 transaction is an eligibility response.

65. B — Claim submission deadline

Timely filing rules establish the deadline for submitting a claim to a payer.

66. C — Deductible

A deductible is the amount the patient generally pays before applicable plan benefits begin paying.

67. B — Fixed dollar amount

A copayment is generally a fixed dollar amount.

68. B — Percentage

Coinsurance is generally a percentage of the applicable allowed amount.

69. A — Insurance coverage payment

A premium is paid to maintain insurance coverage.

70. B — Payer-recognized amount

The allowed amount is the amount recognized under the applicable plan for a covered service.

71. A — HMO

HMOs generally emphasize network-based and coordinated care.

72. B — PPO

PPOs generally provide greater flexibility and may provide some out-of-network coverage at a higher cost.

73. A — Coordination of Benefits

COB determines payment responsibility when a patient has multiple insurance plans.

74. B — Primary vs secondary

COB establishes which payer is primary and which is secondary.

75. B — Payer approval

Prior authorization is approval required by some payers before certain services are performed.

76. B — No

Prior authorization does not guarantee payment. Other requirements can still affect reimbursement.

77. A — Part A

Medicare Part A primarily covers inpatient hospital insurance and certain related services.

78. B — Part B

Medicare Part B primarily covers physician and outpatient medical services.

79. D — Part D

Part D provides prescription drug coverage.

80. B — Medicare Advantage

Part C is Medicare Advantage.

81. B — Patient health information and privacy

HIPAA establishes important privacy and security protections for health information.

82. B — Protected Health Information

PHI means Protected Health Information.

83. C — Unauthorized access

Accessing a patient’s record without a legitimate need can violate HIPAA.

84. B — Limit PHI appropriately

The minimum necessary principle generally means limiting PHI use or disclosure to what is reasonably necessary for the intended purpose.

85. C — Nonmaleficence

Nonmaleficence means “do no harm.”

86. A — Autonomy

Autonomy means respecting a patient’s right to make informed decisions.

87. B — Higher-level service

Upcoding means reporting a higher-level service than is supported by the documentation.

88. B — Separating bundled services

Unbundling occurs when services that should be reported together are improperly separated.

89. B — Billing for services never provided

Knowingly billing for services that were never performed is an example of fraud.

90. B — Improper practices

Abuse involves practices that may result in unnecessary costs or improper payment.

91. A — Explanation of Benefits

An EOB explains how an insurance payer processed a claim.

92. B — Explains claim processing

An EOB is generally not the same thing as a patient bill.

93. A — Electronic Remittance Advice

ERA is the electronic version of remittance information.

94. A — Money owed to the healthcare organization

Accounts receivable represents outstanding money owed.

95. B — Organize unpaid balances

A/R aging reports categorize unpaid balances by how long they have been outstanding.

96. B — Old unpaid account

Older unpaid accounts can become more urgent because of deadlines and collection concerns.

97. B — Review the denial

The biller should first understand the denial and verify the authorization requirements before deciding what action is appropriate.

98. B — Correct based on documentation

Modifiers must be supported by the documentation and applicable coding rules.

99. B — Verify authorization

PHI should not be disclosed until the biller verifies that the caller is authorized to receive it.

100. B — Code documentation

The safest fundamental coding rule is: Code what is documented and follow official coding guidelines.

SCORING

90–100: Excellent
You are likely ready for intensive final review. Focus on weak areas and practice application questions.

80–89: Good
You have a strong foundation. Review missed questions and memorize high-yield terminology.

70–79: Needs Review
You understand many concepts but should spend additional time reviewing coding, claims, insurance, and compliance.

Below 70: Significant Review Needed
Go back through the study guide by section and retake the practice exam after reviewing the material.

HIGH-PRIORITY TOPICS TO MEMORIZE

ICD-10-CM = Diagnoses
CPT = Procedures/services
HCPCS Level II = Supplies/equipment/medications and other services
CMS-1500 = Professional claims
UB-04 = Institutional claims
NPI = 10 digits
POS 11 = Office
POS 21 = Inpatient hospital
POS 22 = Hospital outpatient
Modifier -25 = Significant, separately identifiable E/M
Modifier -26 = Professional component
Modifier -TC = Technical component
Modifier -59 = Distinct procedural service
837 = Claim
835 = Remittance
270 = Eligibility inquiry
271 = Eligibility response
Deductible = Amount paid before applicable benefits
Copay = Fixed amount
Coinsurance = Percentage
Medicare A = Hospital
Medicare B = Medical/outpatient
Medicare C = Medicare Advantage
Medicare D = Prescription drugs
Rejection = Correct and resubmit
Denial = Investigate and take appropriate action
EOB = Explanation of Benefits
ERA = Electronic Remittance Advice
HIPAA = Privacy/security of health information
PHI = Protected Health Information
Upcoding = Reporting a higher service than supported
Unbundling = Improperly separating bundled services
Medical necessity = Service is reasonable and necessary for diagnosis/treatment
COB = Determines primary and secondary insurance
Timely filing = Claim submission deadline