Test Your Billing Knowledge

Multiple Choice

1. What does timely filing mean?

a. You have one year for all contracts to file a claim with the insurance company

b. Per govenment regulations, you have only 30 days from the date of service to file insurance claims

c. You must file the claim within a set amount of time your insurance contract indicates to be paid

d. You must file the claim within 60 days of dictation by the provider


 What is the definition of a MCO?

a. A health care provider or a group or organization of medical service providers who offers managed care health plans

b. A health care insurance offered through Medicare or Medicaid only

c. A health care facility such as a Urgent Care or Emergency Department

d. A health care provider or group or organization of medical service providers who work on a capitation basis for payment

3. If the doctor is a Participating Provider, what does this mean?

a. The payment goes to the patient and the doctor must bill the patient for any services rendered

b. The physician is a certified HIPAA doctor

c. Physician will accept the amount paid by the insurance company and will be responsible to write-off the non-allowed amount

d. The physician can charge what they feel is reasonable and customary for their geographical location and will be paid 100% of their fee


Both parents have insurance on their children. The father’s birthday is September 9th and the mother’s birthday is May 20th. Whose insurance is primary?

a. Father’s insurance is primary

b. Mother’s insurance is primary

c. It is determined by who has had the insurance the longest

d. It is determined by which parent is the oldest

5. When a claim is "denied" by the insurance carrier. What is your next step?

a. Write off the charge because it cannot be billed to the patient

b. Investigate to see why it was denied and rebill with information to support payment

c. Appeal claim with State Insurance Commissioner

d. Give all appeals to your office adminstrator or physician for them to review before you write off any charges


What does Claim Adjudication mean?

a. Claim is reviewed by the insurance company to make sure it correct for demographics, codes, payer rules have been followed and
          are covered benefit under the patient’s insurance contract

b. This is the process a claim goes through for all appeals or denials that are refiled by the provider

c. These are the claims that have been preauthorized for surgical procedures

d. This is the credentialing process the physician must go through to become a provider with an insurance company


The insurance companies will hire companies to review the appropriateness and medical necessity of procedures, surgeries and other services. This takes the burden off the insurance company off not authorizing a service due to cost. What are these types of services called?

a. Third Party Payers

b. Utilization Review Organization

c. Case Management Coordinators

d. Managed Care Organizations

8. This patient is seen for removal of two lesions. The cost of the first lesion removal is code 11422 and is for $75.00. The second lesion removal is code 11444 and the cost is $125.00. How would these lesions be billed?

a. 11422, 11444

b. 11422, 11444-51

c. 11444, 11422

d. 11444, 11422-51

9. This patient is seen in the office for chest pain. The doctor performs a EKG and orders labs. The doctor’s level of visit for this patient is a 99214. He decides to admit him to the hospital. The doctor performs an hospital admit later that day. How would the doctor charge for his services?

a. 99214, EKG, labs and hospital admit

b. EKG, labs and hospital admit

c. 99214, EKG, labs

d. Hospital admit only

10. This patient is seen in the office for a wrist fracture. The doctor performs x-rays and applies a lower plaster cast on the patient. This doctor will also continue to see the patient for follow-up care. How would the doctor charge for his/her services?

a. Office visit, x-rays, application of cast and casting supplies

b. Office visits, x-rays, and casting supplies

c. Fracture code, x-rays and casting supplies

d. Fracture code, x-rays, application of cast, casting supplies


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