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....