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 clinician’s no-show rate is 18% this month. What is the best first step?
Remove the clinician’s open slots Check whether reminders went out and how far ahead appointments were booked, then review the cancellation policy with the patients involved Charge every patient a no-show fee immediately Ignore it, no-shows are normal in therapy
Question 8 8. A new therapist starts in three weeks. When should payer credentialing have started?
On their first day After their first month 60–120 days before the start date, as soon as the offer is signed Only after a patient asks to use insurance
Question 9 9. Which KPI tells the owner how long, on average, it takes to get paid for a session?
Utilization rate Days in A/R No-show rate Net promoter score
Question 10 10. A clinician sees 22 patients a week against 30 available slots. Their utilization is about:
22% 58% 73% 136%
Question 11 11. Which item belongs on a clinician onboarding checklist before they see their first insurance patient?
Office plant preferences Active state license verified, NPI, CAQH attested, and in-network effective date confirmed with each payer A personal email account for patient messages Their social media handles
Question 12 12. A front desk coordinator keeps making the same scheduling mistake. What do you do?
Correct it yourself every time Write it in a performance review next year Show them the mistake privately, update the SOP so the step is clear, and check the next few bookings Tell the owner first
Question 13 13. A clinician’s license expires next month. Whose job is it to notice?
Only the clinician’s The patient’s The practice manager tracks every license, CAQH attestation and malpractice policy on a compliance calendar with 90-day reminders The insurance company’s
Question 14 14. The owner wants to know if the practice can afford to hire another clinician. What do you bring?
A gut feeling Current waitlist size, utilization of existing clinicians, collections per session and the expected time to credential a new hire A list of job boards The number of website visitors
Question 15 15. A former patient asks for a copy of their records. Under HIPAA, how long does the practice generally have to respond?
1 year 30 days, with one 30-day extension if the patient is told why The practice can refuse any request 24 hours
Question 16 16. A payer requests records for 15 sessions billed as 90837, due in 21 days. Which step is never acceptable?
Logging the deadline the day the letter arrives Reviewing the notes with the clinician Adding missing session times to the notes before sending them Sending only the records requested through the payer’s secure channel