CDC CDC Dental Insurance & Billing 2 — Questions and Answers
Question 1: Which organization develops and maintains the Current Dental Terminology (CDT) code system?
- American Medical Association (AMA)
- American Dental Association (ADA) (Correct answer)
- Centers for Medicare & Medicaid Services (CMS)
- HIPAA Compliance Board
Correct answer: American Dental Association (ADA)
The American Dental Association (ADA) owns, develops, and annually updates the CDT code system used for dental procedure reporting.
Question 2: What is a predetermination in the dental insurance process?
- A pre-authorization required for all emergency services
- A prior estimate of insurance benefits for planned dental treatment submitted before services are rendered (Correct answer)
- A determination of the patient's annual deductible
- An insurance policy renewal calculation
Correct answer: A prior estimate of insurance benefits for planned dental treatment submitted before services are rendered
A predetermination is a voluntary submission to the insurance company before treatment begins to estimate covered benefits for proposed procedures.
Question 3: What is the standard claim form used to submit dental insurance claims in the United States?
- CMS-1500
- UB-04
- ADA Dental Claim Form (Correct answer)
- HIPAA-837P
Correct answer: ADA Dental Claim Form
The ADA Dental Claim Form is the nationally standardized form used for submitting dental insurance claims; electronically it is transmitted as the HIPAA 837D transaction.
Question 4: What is a fee schedule in the context of a participating dental insurance plan?
- The dental office's appointment booking system
- A predetermined list of fees the insurance plan will pay for specific dental procedures (Correct answer)
- The patient's personal payment installment plan
- The timeline for annual insurance renewal dates
Correct answer: A predetermined list of fees the insurance plan will pay for specific dental procedures
A fee schedule is the fixed list of maximum allowed fees for each procedure that contracted dentists agree to accept as payment in full from the insurance plan.
Question 5: Which CDT code represents a periodic oral evaluation for an established patient?
- D0120 (Correct answer)
- D0150
- D0180
- D0160
Correct answer: D0120
D0120 is the CDT code for a periodic oral evaluation—a routine recall exam for an established patient.
Question 6: Which billing practice occurs when a dental office bills separately for procedures that should be submitted under a single inclusive code?
- Bundling
- Unbundling (Correct answer)
- Up-coding
- Balance billing
Correct answer: Unbundling
Unbundling is the fraudulent practice of billing separate CDT codes for components of a procedure that the payer considers included in one comprehensive code.
CDC CDC Dental Insurance & Billing 2
Which organization develops and maintains the Current Dental Terminology (CDT) code system?