Billing Specialist Knowledge Assessment

Before you hire a biller, you need to make sure he or she is qualified for the position. The following test coupled with a math test will assess whether the candidate will be successful in the role — and an asset to your company.

Name: _____________________________________________  Date: _______________

1. A CPT code has _______ digits and an ICD-9-CM code has _______ digits
2. Explain the difference between a CPT code and an ICD-9-CM code
3. What is the purpose of a modifier?
4. What are E&M codes?
5. What does “COB” stand for?  
6. What insurance information do you obtain when the patient contacts our office with new insurance?
7. If the patient has Medicare, Tricare and Medicaid, which insurance would you bill first, second, last? 
8.  Patient is 65; has BCBS through employer w/ 100+ employees and has Medicare Part A only.  Which insurance would you file first?
9. What does HIPAA stand for? And what does it mean to you? 
10. What is a CMS 1500 used for?
11. What is the difference between HCFA and CMS 1500?
12. How would you handle each of the following EOB rejections?
    • Procedure not a covered benefit
    • Patient not eligible on the date of service
    • Applied to deductible 
    • Bundled Service

 

Multiple Choice

1. A “crossover” claim is:

a. When Medicare forwards a claim electronically to a secondary insurance carrier

b. When duplicate claims are sent and the same claim is returned for more information. (essentially the two claims are “crossing” in the mail)

c. When a claim is sent that has more than one box “crossed out”

d. Sending the claim to the secondary insurance first for administrative purposes, “crossing” the normal procedural policies.

 

2. An EOB is:

a. End of Balance

b. Examination of Benefits

c. Explanation of Benefits

d. Existing Observation Board

 

3. When a physician accepts “assignment” for a Medicare patient, the physician:

a. Agrees to have Medicare pay him/her directly

b. Agrees to collect the payment from the patient

c. Must collect the patient co pay up front

d. Must only accept what Medicare pays; do not “balance bill” the patient

 

4. A Remittance is received without payment and the message indicates that the referring/ ordering physician NPI is needed.  What should you do?

a. Adjust off the amount not paid

b. Resubmit the claim with the correct NPI

c. Ignore the Remittance

d. Post the denied amount as paid

 

5.   A patient calls and says her insurance will pay her claim if you use a different diagnosis code than was billed.  What do you do?

a. Pull the Medical Record and find a way to code that diagnosis

b. Tell the patient that we never alter a diagnosis code

c. Note the account and hope the patient doesn’t call back

d. Pull the Medical Record and give it to a certified coder for review and resolution

 

 

Matching – Select the correct letter

	E&M	A.	A provider who is participating in the plan
	PHI	B.	Provides coverage for physician and outpatient services
	Secondary Insurance	C	Protected Health Information
	PCP	D	A federal health insurance program that provides benefits to indigent or low income people
	PPO	E	Key components are: history, examination, and medical decision making
	Par Provider	F	The insurer that reimburses for benefits after the primary insurer has paid
	Medicare Part B	G	Coverage for hospital, nursing homes, home health, and inpatient care.
	Medicare Part A	H	A plan contracting with providers to provide services on a discounted basis.  Members must stay “in plan” or pay a greater co pay or portion of their bill.
	Medicaid	I	A statement that is mailed to both the patient and the provider explaining claim adjudication and payment
	EOB	J	Primary Care Physician

 

True/False

 

True	False	Providers are always required to take commercial insurance companies contractual adjustments.
True	False	A patient over the age of 65 who is working will still always have Medicare as his/her primary insurance coverage.
True	False	If you receive a payment reduction due to “out of network” you are allowed to bill the patient the balance on the claim.
True	False	A co-pay is a specified flat amount for a designated service, usually paid for at the time of service.
True	False	You are not allowed to bill patient’s for out of timely denials if you are a contracted provider with that plan.
True	False	If you receive a denial from an insurance plan for “duplicate claim,” you must write off the balance on the account for that date of service.
True	False	ABN’s are not needed for services which will be denied based on statutory exclusion (services which are never covered by Medicare).
True	False	You do not need to send a primary insurance EOB along with the claim form when billing a secondary insurance.
True	False	When billing an E&M service with a procedure and using the -25 modifier, the modifier is always attached to the procedure.
True	False	Coinsurance is what the patient must pay before their coverage begins

 

Applicant Signature: ______________________________________________________

36        Questions Total

____    Right answers

____    Score  (X/36)