Question 1 1. A caller says she is the patient’s mother and asks why her adult son’s claim was denied. There is no release on file. What do you do?
Explain the denial, since she is family Confirm only the date of service Explain you can’t share account details without the patient’s authorization, and offer to have the patient call or sign a release Transfer the call to the clinician
Question 2 2. What is the first thing to do before discussing a balance with a caller who says they are the patient?
Read them the balance Verify identity with at least two identifiers Ask for a card number Ask which therapist they see
Question 3 3. An upset patient says, "Nobody told me I would owe anything." The best first response is:
"That’s not our fault, it’s your insurance." "I understand this is frustrating. Let me pull up the statement and walk you through each charge." "You signed the financial policy." "I’ll send it to collections if it isn’t paid."
Question 4 4. You can’t resolve a patient’s dispute on the first call. What should happen next?
Promise a refund to close the call Tell them to call back later Document the call, give a specific follow-up date, and escalate per the practice’s matrix Ask the patient to contact their insurance and close the ticket
Question 5 5. Which is safe to send to a practice owner by regular, unencrypted email?
A patient’s name with their diagnosis code A spreadsheet of denied claims with member IDs Aggregate numbers, such as "14 claims denied for CO-16 this week", with no patient identifiers A screenshot of the EHR billing screen
Question 6 6. A patient asks for a payment plan on a $600 balance. You should:
Agree to any terms they suggest Refuse; balances are due in full Offer the options the practice’s financial policy allows, confirm the terms in writing and set up the schedule Waive the balance to keep the patient
Question 7 7. A patient’s plan has a $1,500 deductible with $400 met, and the allowed amount for a 90837 is $160. What does the patient owe for this session?
$0, the plan pays first $160, the full allowed amount A $30 copay only $400
Question 8 8. On an EOB, the amount labeled "PR" (patient responsibility) is:
Written off by the practice Owed by the patient under their plan A payer penalty Paid by secondary insurance automatically
Question 9 9. A practice owner asks why collections dropped this month. What is the most useful reply?
"Insurance is slow lately." A short summary with the numbers: claims submitted vs. paid, top denial reasons, what you are doing about each, and when they will see the effect Send the full A/R export with no comment "I’ll look into it."
Question 10 10. Which CPT code is used for a psychiatric diagnostic evaluation (intake) without medical services?
90834 90837 90791 99214
Question 11 11. A 50-minute individual psychotherapy session should be billed as:
90832 90834 90837 90791
Question 12 12. A claim is denied with CARC CO-16. What does that usually mean?
Patient not covered on the date of service Claim is missing information or has a billing error Timely filing limit expired Service not medically necessary
Question 13 13. Which place of service code and modifier are most commonly used for a telehealth session delivered to a patient at home (for payers that follow CMS)?
POS 11, no modifier POS 10 with modifier 95 POS 02 with modifier 25 POS 22 with modifier GT
Question 14 14. A secondary insurance exists. When do you bill it?
At the same time as the primary After the primary pays, attaching the primary EOB Never; the patient pays instead Only if the primary denies
Question 15 15. On an ERA, CO-45 next to a payment means:
The claim was denied The charge exceeds the contracted rate, and the difference is written off; the patient can’t be billed for it The patient owes the amount Timely filing expired
Question 16 16. A payer paid $92 on 90837 claims all month, but the contract says $118. What do you do?
Post it and move on Bill the patient the $26 Document the underpayments, open a ticket or reconsideration with the payer citing the contract, and tell the practice Write it off