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. Which denial is best prevented by checking eligibility before every first session and at the start of each month?
CO-27 / coverage terminated CO-97 / bundled service CO-45 / contractual adjustment PR-2 / coinsurance
Question 10 10. When should a patient’s copay be collected?
After the claim is paid At check-in or before the session, from the card on file per the practice’s policy At the end of the month Only if the patient offers
Question 11 11. A patient cancels two hours before the session. The signed policy requires 24 hours’ notice. What do you do?
Nothing, cancellations are free Apply the late-cancellation fee the patient agreed to, explain it kindly, and log any exception the practice approves Discharge the patient Charge their insurance for the session
Question 12 12. A new patient calls to book. Which question must you ask before scheduling a telehealth intake?
Their favorite clinician Which state they will be in during sessions Their employer’s name How they heard about the practice
Question 13 13. A statement shows: billed $200, allowed $140, insurance paid $112. If the practice is in network, what does the patient owe?
$88 $60 $28 $0
Question 14 14. A patient’s card on file is declined for a $35 copay. What is the best next step?
Cancel all future sessions Contact the patient the same day, ask for an updated card, and note the account; follow the policy if it isn’t resolved Send the balance to collections Try the card ten more times
Question 15 15. A patient asks for an itemized statement for their HSA. What do you send?
A screenshot of the EHR A statement with dates of service, CPT codes, amounts paid and the practice’s tax ID, through the secure portal Their full chart Nothing; HSAs don’t need it