Free Medical Billing General Question and Answers

Question 1

What is the acronym of Early and Periodic Screenings-Diagnosis-and Treatment?

Accepted Answer

EPSDT

Answer

EPSDT stands for Early and Periodic Screening, Diagnostic, and Treatment. It is a mandatory Medicaid benefit for children under 21, ensuring comprehensive and preventative healthcare services. The acronym directly represents the full name of this crucial program, which aims to identify and address health problems early.

Question 2

Maggie visits the chiropractor once every week and has Medicaid. Maggie is told by the chiropractor that she must pay a $25 copay for each visit even though she has Medicaid. There is no copay on Marge's insurance card. When Maggie questions the billing office, they inform her that her insurance only pays $17 for each chiropractic visit and that it would be cheaper for her to pay the $25 out-of-pocket. In accordance with Medicaid rules:

Accepted Answer

It is illegal to bill Medicaid patients without signed consent.

Answer

Medicaid is a payer of last resort, and providers are generally prohibited from balance billing Medicaid patients for services covered by Medicaid. If a provider wishes to bill a Medicaid patient for services not covered or for amounts exceeding Medicaid's allowed charges, they must obtain a signed Advance Beneficiary Notice (ABN) or similar waiver from the patient *before* providing the service, clearly stating the patient's financial responsibility. Without such consent, billing the patient directly for the difference is illegal.

Question 3

The time frame for filing a claim with Medicare is:

Accepted Answer

365 days

Answer

Medicare generally requires claims to be filed within one calendar year (365 days) from the date of service. This timeframe ensures timely processing and payment for healthcare providers. Claims submitted after this period may be denied, impacting reimbursement and requiring providers to adhere strictly to this deadline.

Question 4

A test costs $400 and is provided. The patient is responsible for $23.56 while the insurance company pays $300. What are the terms for the contractual discount and the patient's obligation?

Accepted Answer

$76.44, coinsurance

Answer

The contractual discount is the difference between the total cost ($400) and what the insurance company and patient pay together ($300 + $23.56 = $323.56), which is $76.44. The patient's obligation of $23.56, after the insurance has paid a portion, is known as coinsurance, which is a percentage of the cost of a covered healthcare service paid by the patient after their deductible has been met.

Question 5

The sum an insurance provider is charged for services:

Accepted Answer

Each procedure must have a set cost for all insurance companies.

Answer

While the *reimbursement* amount can vary based on contracts with different insurance companies, the *charge* for a specific procedure is typically set by the provider and is the same for all patients and insurance companies. This 'list price' or standard fee schedule is then subject to contractual adjustments and patient responsibility based on individual insurance plans. Therefore, the initial sum charged for services is generally consistent across all payers.

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Medical Billing Software Practice Test

Free Medical Billing General Question and Answers