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Quizzes > Quizzes for Business > Healthcare

Healthcare Call Guideline and Reimbursement Knowledge Test

Test Your Healthcare Call and Billing Expertise

Difficulty: Moderate
Questions: 20
Learning OutcomesStudy Material
Colorful paper art depicting a healthcare trivia quiz about call guidelines and reimbursement knowledge.

Ready to test your grasp of healthcare call protocols and reimbursement rules? This interactive Healthcare Call Guideline and Reimbursement Knowledge Test challenges you with realistic scenarios and multiple-choice questions designed to sharpen your billing and call guideline expertise. Ideal for nurses, medical coders, and healthcare administrators looking to validate their knowledge or prepare for compliance assessments. Feel free to customize this quiz in our editor or explore related tests like the Healthcare Reimbursement Methodology Quiz and the Healthcare Knowledge Assessment Quiz . Dive into our quizzes for more ways to master healthcare guidelines today!

Which of the following is a mandatory element in healthcare call documentation?
Date and time stamp of the call
Patient's favorite color
Office coffee brand
Operator's social security number
A date and time stamp is required to accurately track when advice was given and to maintain a clear chronology of patient interactions. Other items like favorite color or coffee brand are irrelevant. This ensures legal and clinical traceability.
Which communication technique is recommended for gathering comprehensive information during a medical call?
Using open-ended questions
Interrupting frequently
Using complex medical jargon
Multitasking while listening
Open-ended questions allow callers to provide detailed information about their concerns, which leads to more accurate assessment and documentation. Interrupting or using jargon can hinder clarity and rapport. Avoiding multitasking ensures full attention on the caller.
Which code set is primarily used for billing telephone evaluation and management services?
CPT codes
ICD-10 codes
DSM-5 codes
NDC codes
CPT (Current Procedural Terminology) codes include specific telephone evaluation and management service codes. ICD-10 is for diagnoses, DSM-5 for mental disorders, and NDC for drug identification. Telephone E/M is billed via CPT.
Which factor is NOT considered when determining medical necessity for a telephone consultation?
Social or nonclinical reasons
Symptom severity
Risk of complications
Need for medical intervention
Medical necessity focuses on clinical factors like symptom severity, risk, and need for intervention. Social or nonclinical reasons do not justify medical necessity under standard reimbursement criteria.
Which federal regulation governs patient privacy in recorded or documented healthcare calls?
HIPAA
OSHA
ADA
FDA
The Health Insurance Portability and Accountability Act (HIPAA) outlines rules for protecting patient health information during calls and in documentation. OSHA concerns workplace safety, ADA covers disability rights, and FDA regulates drugs and devices.
What essential element should be included in a call note to confirm patient comprehension?
Patient restates the advice in their own words
Call handler's personal opinion
Length of time caller waited on hold
Caller's background music preference
Having the patient restate advice ensures they understood instructions correctly and supports clear documentation. Personal opinions or wait times are not relevant to patient comprehension. Documenting comprehension helps reduce errors.
Which time range corresponds to CPT code 99442 for telephone evaluation and management services?
11 - 20 minutes
5 - 10 minutes
21 - 30 minutes
31 - 40 minutes
CPT code 99442 covers telephone E/M services lasting 11 to 20 minutes of medical discussion. Code 99441 is 5 - 10 minutes and 99443 is 21 - 30 minutes. Time documentation must align with code definitions.
Under Medicare guidelines, telephone E/M services are reimbursable only for which type of patient?
Established patients
New patients
Emergency department patients
Prospective patients
Medicare only reimburses telephone E/M services for established patients. New patients are not covered for standalone phone calls. This ensures continuity of care documentation for existing patients.
A patient calls only to request a prescription refill with no assessment. How should this be coded?
Non-billable service; no separate E/M code
CPT 99441
CPT 99212
HCPCS G2012
Prescription refill without assessment does not meet criteria for an E/M service and is not separately billable. Codes like 99441 require medical discussion; G2012 is for digital communications, not simple refills.
If a telephone claim lacks documented time spent on the call, what billing error is most likely?
Missing required documentation
Upcoding
Duplicate billing
Invalid diagnosis code
Telephone E/M codes require documentation of time spent in the medical discussion. Absence of time documentation is a missing documentation error. Other errors involve code selection or duplication.
According to HIPAA, how long must healthcare entities retain call documentation?
Six years
Two years
Ten years
Indefinitely
HIPAA requires retention of protected health information, including call records, for a minimum of six years from creation or last use. Two years or indefinite periods do not meet the legal requirement.
Active listening techniques in call handling include which of the following practices?
Summarizing the caller's statements
Ignoring the caller's tone
Providing unrelated anecdotes
Multi-tasking during the call
Summarizing what the caller has said demonstrates understanding and helps clarify information. Ignoring tone or multitasking detracts from effective listening, and unrelated anecdotes reduce professionalism.
A claim bills a telephone E/M code on the same day as an in-person visit for the same condition. What is the issue?
Duplicate service billing
Unbundling services
Lack of medical necessity
Disallowed provider type
Billing a telephone E/M code and an in-person E/M on the same day for the same issue constitutes duplicate services and is not allowed. The call is considered part of the in-person visit.
Which code is used for remote evaluation of prerecorded patient information such as images?
HCPCS G2010
CPT 99441
CPT 99203
CPT 99457
HCPCS code G2010 is defined for remote evaluation of prerecorded images or videos. CPT codes 99441 and 99457 cover telephone or remote monitoring services, not prerecorded image review.
For compliance, what must call handlers disclose at the start of a recorded healthcare call?
That the call is being recorded
The caller's social security number
Office coffee policy
Physician's annual salary
Legal and privacy regulations require disclosure when calls are recorded so participants are aware of recording. Personal or irrelevant information like coffee policy is not required.
Which action during a healthcare call is most likely to violate HIPAA privacy rules?
Using speakerphone in a public area
Documenting only clinical information
Encrypting call recordings
Obtaining verbal consent for telehealth
Using a speakerphone in public risks exposing protected health information to unauthorized persons, violating HIPAA. Encrypting recordings and obtaining consent support compliance, and clinical documentation is appropriate.
A patient engaged in 20 minutes of remote care management for hypertension. Which code is appropriate?
CPT 99457
CPT 99441
CPT 99214
CPT 99091
CPT code 99457 covers remote physiologic monitoring and management for a minimum of 20 minutes by clinical staff. Codes 99441 and 99214 cover telephone and in-person E/M, and 99091 is analytics-based data collection.
Under Medicare policy, can a provider bill a telephone E/M service code if a face-to-face E/M visit occurred the same day for the same issue?
No, it is disallowed
Yes, it is allowed without modifiers
Yes, but with modifier 25
Yes, but requires medical director approval
Medicare policy prohibits separate billing of telephone E/M services on the same day as an in-person E/M for the same condition. The telephone call is considered part of the face-to-face visit.
A call involves moderate complexity decision making and lasts 14 minutes. Which code is correct?
CPT 99442
CPT 99441
CPT 99443
CPT 99213
CPT code 99442 applies to telephone E/M services lasting 11 - 20 minutes, which corresponds to a moderate complexity decision-making scenario. 99441 is 5 - 10 minutes, 99443 is 21 - 30 minutes, and 99213 is in-person.
Which federal law requires offering language assistance services to callers with limited English proficiency?
Title VI of the Civil Rights Act
Americans with Disabilities Act
HIPAA
Emergency Medical Treatment and Labor Act
Title VI of the Civil Rights Act prohibits discrimination based on national origin and requires language assistance for limited English proficiency individuals in federally funded programs. ADA covers disability, HIPAA privacy, and EMTALA emergency care.
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Learning Outcomes

  1. Analyze healthcare call documentation guidelines
  2. Apply reimbursement criteria to real-world cases
  3. Demonstrate accurate coding for call notes
  4. Identify compliance requirements in call handling
  5. Evaluate billing claims for potential errors
  6. Master effective communication protocols

Cheat Sheet

  1. Understand the Importance of Call Documentation - Accurately logging every clinically relevant phone encounter builds a clear, chronological story of patient care and reduces confusion when multiple providers get involved. Make it a habit to note symptoms discussed, advice given, and any follow-up plans - even a quick bullet list can feel like detective work in a fun medical mystery! This diligent documentation also acts as a legal safety net if questions arise later. Discover more about call documentation
  2. Master Key Reimbursement Models - From Fee-for-Service to Capitation and Value-Based Payments, each model shapes how providers get paid and how patients are billed. Picture these like the different game modes in your favorite video game - knowing the rules gives you the power to win (and get paid correctly!). With this knowledge, you'll optimize revenue cycles and boost your billing high score. Explore reimbursement models
  3. Apply Accurate Coding Practices - Using the right ICD-10 and CPT codes is like typing in the secret cheat codes for hassle-free reimbursement. When you match codes precisely to the services rendered, claims zip through the system without glitching or getting denied. Plus, accurate coding keeps you in line with healthcare regulations and steers clear of audit pitfalls. Dive into accurate coding
  4. Identify Compliance Requirements in Call Handling - Safeguarding patient privacy and securing informed consent aren't just boring legal hoops - they're cornerstones of trust in healthcare. By following HIPAA guidelines and ethical standards, you protect both patients and your practice from avoidable risks. Think of compliance as your superhero cape - silent but mighty. Brush up on compliance guidelines
  5. Evaluate Billing Claims for Potential Errors - Regularly auditing claims for upcoding, undercoding, or unbundling is like proofreading a term paper before submission - you catch mistakes, refine your work, and earn top marks (or payments). This proactive check dramatically lowers denial rates and speeds up cash flow. Plus, it trains your eye to spot sneaky errors before they snowball. Audit your billing claims
  6. Master Effective Communication Protocols - Clear, concise dialogue over the phone is your secret weapon against misunderstandings and clinical mix-ups. Practice asking open-ended questions, summarizing conversations back to patients, and documenting key points to keep everyone on the same page. Great communication not only enhances patient satisfaction but also streamlines your charting process. Hone communication skills
  7. Understand Payer Guidelines and Requirements - Different insurance payers have unique policies, medical necessity rules, and prior-authorization hoops to jump through. Stay updated by reviewing payer handbooks and policy bulletins - think of it as unlocking new levels in the insurance game. Mastering these requirements ensures timely approvals and smoother reimbursements. Check payer requirements
  8. Recognize the Role of Billing Codes in Reimbursement - Billing codes are the universal language that turns clinical care into payment. When you use codes that precisely match procedures and diagnoses, claims sail through with minimal friction. View each code as a puzzle piece - find the perfect fit, and the reimbursement picture comes together smoothly. Unpack billing codes
  9. Implement Effective Revenue Cycle Management - From patient registration and eligibility verification to final payment posting, each step in the revenue cycle needs fine-tuning. Think of your revenue cycle as a relay race - handoff each baton (task) cleanly to your teammates for record-breaking performance. Good RCM practices keep cash flowing and headaches at bay. Boost revenue management
  10. Stay Updated on Healthcare Reimbursement Laws - Healthcare regulations evolve constantly, and what was acceptable last year might trigger denials today. Dedicate time to read legislative updates, attend webinars, or join professional forums to keep your knowledge fresh. Staying informed means you'll never be caught off guard by new billing requirements. Stay on top of reimbursement laws
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