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Whats your "Billing Sense"?

A detailed and informative medical billing office with people actively engaged in discussions and reviewing documents related to healthcare billing and insurance claims.

Assess Your Billing Knowledge!

Are you ready to test your billing sense? This quiz consists of 10 multiple choice questions that challenge your knowledge of medical billing terms and processes. Perfect for professionals in the healthcare and billing fields!

Topics covered include:

Claim denials
Insurance responsibilities
Medicaid billing
EOB interpretations
Healthplan interactions

10 Questions2 MinutesCreated by BillingExpert927

What does CO-24 mean?

Not eligibile on DOS

An HMO carrier is responsible

An IPA or medical group is responsible

Not medically necessary

If a patient received a Blue Cross payment but says they are filing for bankruptcy and will send you the court docs, what do you do next?

Still hold patient responsible regardless of court docs

Set up a payment plan

Agree to write off the balance once supporting docs received

Call BC to advise to reprocess the claim

Healthshare is a Oregon Medicaid MCO

True

False

You work an Aetna Better Health of OH claim. It was partially paid and noticed all codes except the G-code was paid. What does this mean?

The claim needs to be sent a shortpay appeal

A call need to be made to insurance to reprocess claim

Accept the payment made.

Verify/confirm the plan type & send a corrected claim

Most state Medicaid plans allow 3 units of 83789.

True

False

You received an EOB. All codes paid except 80307 stating "Payment already made on this procedure code". What does that mean? Choose the best answer.

They paid this accession already and we need to locate the missing payment.

Patient may already have another accession that was billed with the same DOS.

The clinic already billed a presumptive code, thus making ours non-reimbursable.

They got it wrong. Call them to reprocess.

What does CO-50 mean?

Not medically necessary

Not eligible on DOS

Medical group is responsible

Invalid patient name

You have a claim partially paid. All codes paid except 80307/G0481 denied as CO-50. What do you do next?

Send a shortpay appeal

Send a corrected claim

Fair Oaks Psychiatric send over diagnosis code F11.20. The patient has HN as the healthplan, with La Salle as the medical group. Who is the responsible payer?

La Salle

Health Net

Neither

You receive a denial from Alameda Alliance the patient isn't eligible on DOS. What is your next step? Choose the best answer.

Call Alameda Alliance to verify claim processed correctly.

Call the patient to discuss bill.

Recheck eligibility to verify if AAH is the correct payer.

Adjust the whole balance off.

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