🏥 Medical Billing
What CPT code represents a 60-minute psychotherapy session?
90837
The most common reason for claim denials.
Eligibility/coverage issues.
CBS operates during these standard business hours in the U.S.
Monday–Friday, 9:00 AM to 6:00 PM EST
When posting charges in OpenPM, what claim status should every completed encounter be set to before saving?
Ready for Submission
What tracking system does CBS use to document submissions, follow-ups, reference numbers, and effective dates?
Praqio
What diagnosis coding system is required for outpatient claims in the U.S.?
ICD-10-CM
What should always be reviewed before appealing a denial?
The denial reason and supporting documentation.
Employees are expected to submit planned PTO requests at least this many days in advance.
7 days
According to the OpenPM SOP, which fields must always be reviewed before marking an encounter complete?
Facility, Rendering Provider, Referring Provider, Diagnosis, DOS, CPT, and Units.
(Who ever names the most)
How often must a CAQH profile be re-attested to remain current?
every 120 days?
What CPT code represents a psychiatric diagnostic evaluation without medical services?
90791
The patient has another insurance that should have paid first. What is the terminology used for this.
Coordination of Benefits (COB).
Name three examples of behavior that can result in immediate disciplinary action or termination
Theft, Harassment, Workplace violence, Insubordination, Vandalism, Unauthorized disclosure of confidential information, Falsifying company records, Drug or alcohol use in the workplace
The Integrated Therapy SOP requires changing the insurance location from GA to NC for which insurance plans when the provider and facility are NC?
Medicare and BCBS
According to our standard workflow, after submitting an application and logging the confirmation, what is the next step?
begin the follow-up cadence? (First follow-up at Day 10, then every 10 business days until an effective date is received.)
What should you verify before submitting every claim?Name at least 5 items
Examples:
Eligibility, Authorization, CPT, ICD-10, Modifiers
NPI, DOS, POS
What is the difference between a rejection and a denial?
Rejection: The claim was never accepted for processing because of errors (missing information, formatting, invalid data).
Denial: The claim was accepted and processed but payment was refused for one or more services.
Name three examples of confidential information employees should protect.
Patient information
Financial information
Employee information
Company records
Passwords
Who has won most ROTMs
Chumki and Akashdeep
Name four items that must be collected before submitting an individual provider's credentialing application.
Any four of:
What should be done in this Scenario:
The payer states "Provider Not Credentialed," but eligibility was verified and the patient has active coverage.
The provider enrollment/credentialing must be investigated before the claim denial is worked.
What should you verify before submitting every claim?Name at least 5 items
Examples:
Eligibility, Authorization, CPT, ICD-10, Modifiers
NPI, DOS, POS
A provider emails PHI to the wrong recipient. What is the first action that should be taken?
Report the incident immediately according to company policy.
Which productivity rule was emphasized repeatedly throughout the 2025 year?
The Two-Minute Rule
A Medicaid provider has been approved individually, but the group enrollment is still pending. Can claims be processed successfully?
No. Most state Medicaid programs require both the rendering provider and the billing entity/group to be enrolled separately before claims can process successfully.