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Quizzes > Quizzes for Business > Healthcare

Healthcare Billing Knowledge Quiz Challenge

Improve your healthcare billing and coding skills

Difficulty: Moderate
Questions: 20
Learning OutcomesStudy Material
Colorful paper art promoting a fun Healthcare Billing Knowledge Quiz.

Ready to sharpen your healthcare billing expertise? This Healthcare Billing Knowledge Quiz tests understanding of claim processes, billing codes, and compliance essentials in 15 detailed questions. Ideal for billing specialists, students, and healthcare professionals looking to refine their workflow. You can compare with our Medical Billing and Coding Quiz or explore compliance scenarios in the Healthcare Compliance Quiz. All questions are fully customizable - find more quizzes to tailor your learning journey.

Which coding system is used to report medical diagnoses?
DSM-5
HCPCS Level II
CPT
ICD-10-CM
ICD-10-CM is the standardized system for coding and reporting diagnoses in healthcare. CPT is used for procedures, HCPCS Level II covers supplies and services, and DSM-5 is a diagnostic manual for mental disorders.
What does the acronym CPT stand for in medical billing?
Clinical Procedure Terms
Common Procedural Tools
Current Procedural Terminology
Current Practice Techniques
CPT stands for Current Procedural Terminology and is the coding system used to describe medical, surgical, and diagnostic services. It is maintained by the American Medical Association.
Which form is commonly used to submit outpatient professional medical claims in the United States?
ADA-2006
837I
UB-04
CMS-1500
The CMS-1500 form is used by healthcare professionals and suppliers to bill Medicare Part B and other health insurance carriers for outpatient services. The UB-04 form is used for institutional claims, and the ADA-2006 is for dental claims.
What does EOB stand for in the context of insurance claims?
Electronic Original Bill
Explanation of Benefits
Explanation of Billing
Electronic Office Billing
An Explanation of Benefits (EOB) is a statement sent by a payer outlining the services billed, payments made, and any patient responsibility. It is not a bill but a summary of claim adjudication.
What is the purpose of a National Provider Identifier (NPI)?
To track patient satisfaction scores
To serve as a provider's state license number
To uniquely identify healthcare providers in electronic transactions
To rate the quality of care provided
The NPI is a unique 10-digit number assigned to healthcare providers to simplify identification in standard transactions. It does not reflect quality ratings or licensing details.
Which CPT modifier indicates that a service was performed by a resident under direct supervision?
-59
-95
-26
-GC
Modifier -GC signals that a service was performed in part or whole by a teaching physician's resident under direct supervision. Modifier -26 indicates professional component only, -59 indicates distinct procedural service, and -95 is used for telehealth.
Which HIPAA transaction set is used for real-time eligibility and benefits inquiries?
835
276/277
270/271
837P
Transaction 270 is the eligibility inquiry and 271 is the response set under HIPAA. The 837P is the professional claim, 835 is the remittance advice, and 276/277 are claim status inquiries and responses.
A claim is denied due to missing preauthorization for a surgical procedure. What is the best next step?
Appeal the denial citing medical necessity
Submit a claim adjustment for billing codes
Bill the patient directly for the procedure
Request preauthorization and then resubmit the claim
If a claim is denied for lack of preauthorization, the correct approach is to obtain the required authorization before resubmission. Appealing without authorization is unlikely to succeed, and billing the patient directly or merely adjusting codes does not address the underlying issue.
In medical billing, what does "bundling" refer to?
Adding modifiers to increase reimbursement
Combining multiple related services into a single comprehensive code
Separating a comprehensive service into multiple codes
Submitting duplicate claims to different payers
Bundling means grouping related procedures under one CPT code to reflect a comprehensive service. Unbundling is the practice of separating services into multiple codes and is generally incorrect.
Which element is mandatory on a standard CMS-1500 claim form to identify the billing provider?
Supervisor's signature
Provider's National Provider Identifier (NPI)
Patient's place of service code
Patient's insurance policy number
The NPI is required to uniquely identify the billing provider on each claim form. While patient policy numbers and place of service are also needed, they do not identify the provider.
Why is documentation of medical necessity critical for claim payment?
It determines the patient's copayment amount
It justifies that services rendered are reasonable and necessary for diagnosis or treatment
It ensures the provider receives an NPI
It speeds up electronic remittance processing
Medical necessity documentation shows that services billed are appropriate for the patient's condition, which payers require to approve payment. It is not used to obtain an NPI or directly calculate copayments.
Which of the following is an example of unbundling?
Using HCPCS Level II codes for supplies
Applying modifier -26 for the professional component
Billing separate CPT codes for components of a comprehensive procedure
Reporting ICD-10-CM codes instead of CPT codes
Unbundling occurs when separate CPT codes for parts of a bundled procedure are billed individually. This practice can lead to overbilling and is generally prohibited by payers.
Which part of Medicare covers inpatient hospital services?
Medicare Part D
Medicare Part A
Medicare Part C
Medicare Part B
Medicare Part A covers inpatient hospital, skilled nursing facility, hospice, and some home health services. Part B covers outpatient services, C is Medicare Advantage, and D covers prescription drugs.
A provider submits a claim to Medicare two years after the date of service. What is the most likely outcome?
The claim will be processed as usual
The claim will be expedited due to age
The claim will be converted to a request for extension
The claim will be denied for late filing
Medicare enforces a 12-month timely filing limit for claims, after which they are denied for late submission. There is no automatic extension or expedited processing for older claims.
What role does a clearinghouse play in electronic claim processing?
Manages patient electronic health records
Translates and forwards claims from providers to payers
Determines medical necessity
Issues preauthorization for procedures
A clearinghouse formats, edits, and transmits electronic claims between providers and payers. It does not adjudicate claims or handle authorizations.
A provider billed CPT code 99214 for an office visit but the documentation supports only a level equivalent to 99212. What is the appropriate correction technique?
Add modifier -25 to justify the higher level
File an appeal to keep the higher level code
Downcode the service to 99212 and resubmit
Leave the original claim unchanged
When documentation does not support the billed level, the correct action is to downcode to the level documented. Using modifier -25 or appealing does not resolve the lack of supporting documentation.
Which regulation specifically sets standards for protecting the privacy of individual health information?
HITECH Act
Anti-Kickback Statute
Stark Law
HIPAA Privacy Rule
The HIPAA Privacy Rule establishes standards to protect individuals' medical records and personal health information. The Stark Law deals with physician self-referral, the Anti-Kickback Statute addresses illicit payments, and HITECH promotes health IT adoption and strengthens HIPAA.
Under NCCI edits, which modifier is used to indicate a distinct procedural service to bypass bundling edits?
-25
-TC
-26
-59
Modifier -59 identifies a procedure as distinct or separate from other services performed on the same day, allowing it to bypass certain bundling edits. Modifier -26 is for professional component, -TC for technical component, and -25 for significant, separately identifiable E/M services.
A patient receives a preventive medicine visit and a problem-focused E/M service on the same date. How should the clinician report both services?
Report only the preventive medicine code
Report both codes and append modifier -25 to the E/M service
Report both codes and append modifier -33 to the preventive service
Report only the problem-focused E/M code
When a problem-focused E/M service is provided on the same day as a preventive medicine visit, modifier -25 is appended to the E/M service to indicate it is distinct and separately billable. Modifier -33 is for preventive services flagged by payers.
Within what timeframe must a Medicare Part B claim appeal be filed after the date on the Medicare Summary Notice?
60 days
1 year
120 days
6 months
A Medicare Part B claimant must file an appeal within 120 days of the date shown on the Medicare Summary Notice. Appeals filed after this window are typically dismissed for untimeliness.
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Learning Outcomes

  1. Analyse common medical billing codes and procedures
  2. Identify insurance claim requirements and documentation standards
  3. Apply coding principles to real-world billing scenarios
  4. Evaluate error correction techniques for accurate claims
  5. Demonstrate understanding of compliance in billing regulations

Cheat Sheet

  1. Key medical coding systems - Think of ICD-10, CPT, and HCPCS as the secret languages that keep healthcare billing in sync - ICD-10 for diagnoses, CPT for procedures, and HCPCS for services and equipment. These codes are updated regularly to reflect new treatments and technologies, so staying current means you're always speaking the right "doctor." CMS coding guide
  2. Insurance claim requirements - Filing a claim is like submitting a perfect recipe: you need all the ingredients (documentation) and the exact measurements (correct codes) to get the desired result (reimbursement!). Missing or wrong info can delay payment, so mastering these requirements is your ticket to faster claim approvals. CMS claim coding info
  3. Hands-on coding practice - Theory is great, but nothing beats rolling up your sleeves and coding real-world scenarios. Practicing with sample cases helps you internalize guidelines, sharpen your decision-making, and build confidence for when the billing bell rings. PMC coding practice article
  4. Common coding errors - Beware of unbundling, undercoding, and modifier mishaps - these little slip-ups can lead to claim denials or audits. Learning to spot and sidestep these errors keeps your billing clean and compliant (and your stress levels low!). Apex MedPro error guide
  5. Compliance with billing regulations - The National Correct Coding Initiative (NCCI) edits are your billing watchdogs, preventing improper code pairings and ensuring fair payment. Following these rules not only keeps you out of hot water but also earns you a reputation as a coding pro. NCCI policy manual
  6. Staying updated on coding changes - Coding standards evolve faster than smartphones, so regular training and industry updates are your best friends. By sharpening your skills constantly, you'll slash errors and stay a step ahead in the billing game. Experian billing best practices
  7. Ethical standards in coding - Accuracy, integrity, and patient confidentiality aren't just buzzwords; they're the pillars of ethical medical coding. Upholding these values builds trust with patients and providers, ensuring everyone wins. AHIMA ethical coding standards
  8. Evaluation & Management (E&M) coding - E&M codes capture the story behind each patient visit, reflecting medical complexity and decision-making. Mastering these codes means your billing mirrors the true value of the care you provide. PMC E&M coding overview
  9. Revenue codes in hospital billing - Revenue codes pinpoint the "where" and "what" of services, making sure hospitals get paid for every part of a patient's stay. Get them right, and you'll keep the cash flow healthy. Bridgespan Health coding guidelines
  10. Patient billing guidelines - Transparent billing policies, including financial assistance and debt collection rules, help patients understand their bills - and reduce surprise sticker shock. Clear guidelines build trust and pave the way for smoother payment experiences. AHA patient billing guide
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