General Billing
What is the purpose of a CPT (Current Procedural Terminology) code in medical billing?
A. To record patient demographics
B. To describe medical procedures and services
C. To document insurance coverage
D. To identify diagnosis codes
B. To describe medical procedures and services
1. What is the purpose of ICD-10-CM codes?
A. To describe medical procedures
B. To identify diagnoses and health conditions
C. To track medication usage
D. To explain insurance coverage
B. To identify diagnoses and health conditions
What is “payment posting” in back‑end RCM?
A) Entering patient insurance information before service
B) Recording payments received from insurance or patients against billed charges
C) Scheduling patient appointments
D) Submitting claims to payers
Recording payments received from insurance or patients against billed charges
Which of the following is a core function of front‑end RCM?
A) Posting payments after insurance adjudication
B) Denial management after claim submission
C) Verifying patient insurance eligibility before service
D) Auditing provider claims compliance
C) Verifying patient insurance eligibility before service
What is primary care in a healthcare system?
A) Specialist services like neurology or cardiology
B) Hospital inpatient care only
C) First point of consultation for general health issues, like family doctors, general practitioners, or community clinics
D) Emergency surgery units
C) First point of consultation for general health issues
Which document must be checked before submitting a claim to ensure the patient is covered for a service?
A. Explanation of Benefits (EOB)
B. Medical chart
C. Insurance eligibility verification
D. Payment receipt
C. Insurance eligibility verification
What does CPT stand for?
Current Procedural Terminology
Which of the following is a common reason for a medical claim denial?
A) Patient showed up on time
B) Incorrect or missing diagnosis code
C) The provider has more than one specialty
D) The patient paid the co‑pay
B) Incorrect or missing diagnosis code
What is the primary goal of patient registration in front‑end RCM?
A) To determine reimbursement rates for all procedures
B) To collect correct and complete demographic and insurance information
C) To track providers’ performance metrics
D) To submit appeals for denied claims
B) To collect correct and complete demographic and insurance information
Which of the following best defines public health?
A) Health services provided only in private hospitals
B) Actions societies take to prevent disease, promote health, and prolong life in populations
C) Health insurance policies
D) Medical treatments after illness has occurred
B) Actions societies take to prevent disease, promote health, and prolong life in populations
What does the term “co-pay” refer to in medical billing?
A. The total amount billed to insurance
B. The fixed amount a patient pays at the time of service
C. The percentage the provider charges after insurance
D. A penalty for late claim submission
B. The fixed amount a patient pays at the time of service
What is the main difference between ICD and CPT codes?
A. ICD codes are for insurance companies; CPT codes are not
B. ICD codes are used for procedures; CPT codes are for diagnoses
C. ICD codes identify diagnoses; CPT codes describe procedures
D. They are used interchangeably
ICD codes identify diagnoses; CPT codes describe procedures
What is “accounts receivable (A/R) aging” used for in back‑end RCM?
A) Measuring how long it takes for claims to be submitted
B) Tracking how long payment has been owed (unpaid) by insurance or patients
C) Determining provider staffing levels
D) Scheduling lab tests
B) Tracking how long payment has been owed (unpaid) by insurance or patients
What is a purpose of prior authorization in front‑end RCM?
A) To negotiate payer contracts after a service has been provided
B) To confirm in advance that a payer will pay for a planned service
C) To post payment from the insurance company
D) To calculate patient co‑insurance after billing
B) To confirm in advance that a payer will pay for a planned service
Explanation: Prior authorizations are done pre-service to reduce the risk of denials because a payer requires certain procedures to be approved beforehand.
What does healthcare access mean?
A) Having too many doctors in an area
B) The ease with which individuals can obtain needed medical services
C) Patients paying more for services
D) Medical technology availability only
B) The ease with which individuals can obtain needed medical services
A claim is denied due to “lack of medical necessity.” What should the billing staff do next?
A. Resubmit the claim without changes
B. File an appeal with additional documentation
C. Send the bill directly to the patient
D. Cancel the claim entirely
Answer: B. File an appeal with additional documentation
Which organization maintains the CPT coding system?
American Medical Association (AMA)
Which function is a key part of denial management in back‑end RCM?
A) Verifying patient eligibility at check‑in
B) Reviewing and appealing claims denied by payers
C) Conducting patient satisfaction surveys
D) Scheduling medical appointments
B) Reviewing and appealing claims denied by payers
Point‑of‑service payment collection refers to:
A) Collecting payment from the insurance payer after claim adjudication
B) Collecting patient co‑pay, deductible, or fees at the time the patient receives service
C) Sending invoices to patients weeks after service date
D) Applying write‑offs for non‑covered services
B) Collecting patient co‑pay, deductible, or fees at the time the patient receives service
Which is an example of preventive care?
A) Open heart surgery
B) Routine vaccination
C) Chemotherapy
D) Emergency room visit
B) Routine vaccination
A provider sees a patient for a 25-minute follow-up visit regarding hypertension and renews two medications. Which CPT code is most appropriate for this established patient visit?
A. 99211
B. 99212
C. 99213
D. 99214
C. 99213
What does a medical coder do with documentation from a healthcare provider?
A. Translate it into standardized codes for billing and recordkeeping
B. Rewrite it for patient understanding
C. Send it directly to insurance companies without review
D. Archive it without any changes
A. Translate it into standardized codes for billing and recordkeeping
Which of the following improvements would most directly help reduce “days in accounts receivable (A/R)” in the back‑end RCM process?
A. Increasing marketing efforts to attract more patients
B. Automating payment posting and claim scrubbing prior to submission
C. Hiring more front‑desk staff to schedule appointments
D. Reducing the number of follow‑up attempts with payers
Automating payment posting ensures faster reconciliation of payments, while claim scrubbing before submission reduces denials and rework, both of which accelerate revenue realization and shorten days in A/R.
Which front‑end task helps reduce the risk of a claim being rejected because of incorrect patient insurance or coverage?
A) Charge capture
B) Eligibility & benefits verification
C) Payment posting
D) Denial appeals
B) Eligibility & benefits verification
What is health equity?
A) Everyone getting the same treatment regardless of need
B) Differences in health outcomes across populations due to unfair or avoidable factors
C) Ensuring everyone has access to the same resources so they can reach their full health potential
D) Only rich people get quality care
C) Ensuring everyone has access to the same resources so they can reach their full health potential