\n \n
\n 1) When would you bill Medical Insurance first when a patient is having 3rd molars\n removed?*
\n
3 points
\n
\n \n A) When Dental insurance requires a Medical EOB for processing
\n B) When office is in Network with Medical
\n C) Never Oral Surgery is not a Medical expense
\n D) A and B\n
\n \n \n
\n
\n 2) Claim has been processed by Dental, all procedures were covered under the plan,\n can Medical be billed as secondary insurance for any remaining balance?*
\n
3 points
\n
\n \n A) Yes
\n B) No
\n \n \n \n
\n
\n 3) How would you proceed if a dental insurance company asked for a medical EOB?*
\n
3 points
\n
\n \n A) Bill to medical and submit medical EOB as attachment to dental claim once received\n
\n B) Close claim and bill the patient for the remaining balance
\n C) Tell the patient to bill medical and close the dental claim
\n \n \n
\n
\n 4) Can Dental be billed if Medical applied treatment to patient’s deductible?*
\n
3 points
\n
\n \n A) Yes\n
\n B) No
\n \n \n
\n
\n 5) Medical applied treatment to patient's deductible, Dental has been billed and no\n payment is issued by Dental. What possible reason(s) would cause dental to not make a\n payment? *
\n
3 points
\n
\n \n A) Plan Max was reached
\n B) Dental did not receive the Medical EOB
\n C) Non Duplication of Benefits provision for Dental Plan
\n D) All of the above\n \n \n \n
\n
\n 6) What Diag Code is routinely used for impacted 3rd molar extractions?*
\n
3 points
\n
\n \n A) K00.6
\n B) K01.1\n
\n C) K04.1\n \n \n
\n
\n 7) Where do you usually find the diagnosis code for a biopsy?*
\n
3 points
\n
\n \n A) Patient's Chart
\n B) Path Report\n
\n C) Doctors Narrative - SOAP notes\n \n \n
\n
\n 8) When submitting a claim to BCBS medical, where would you submit the claim to?*
\n
3 points
\n
\n \n A) The address on the card
\n B) Same address as the dental
\n C) To the home plan address where services were rendered\n
\n \n \n
\n
\n 9) When you submit a medical claim for the removal of 3rd molars, which codes can\n you use?*
\n
3 points
\n
\n \n A) CDT codes
\n B) CDT with ICD-10 codes
\n C) CPT with ICD-10 codes
\n D) B or C\n \n \n \n
\n
\n 10) When do you submit a claim for a biopsy?*
\n
3 points
\n
\n \n A) On the Date of Service
\n B) When the office asks you too
\n C) When the doctor provides a narrative
\n D) When Path report is returned\n \n \n \n
\n
\n 11) What attachments would you send with a claim that has billed D7286?*
\n
3 points
\n
\n \n A) A narrative
\n B) X-ray
\n C) Path Report \n
\n D) Operative Notes\n \n \n
\n
\n 12) You receive an EOB that denied D9223 stating criteria for benefits not met. You 3 points\n look at the office insurance verification and it states D9223 covered at 80%. What is\n your next step?*
\n
3 points
\n
\n \n A) Post payment and close the claim
\n B) Submit an appeal with narrative describing medical necessity for D9223\n
\n C) Post payment and add note that D9223 was denied as a non covered service\n \n \n
\n
\n 13) Form CMS1500 is the correct claim form to be used to bill Medical.*
\n
3 points
\n
\n \n A) True \n
\n B) False
\n \n \n
\n
\n 14) An office has attempted an extraction of a tooth and left root tips for the Oral\n Surgeon to complete the extraction. What should be the correct billing of these\n extractions? *
\n
3 points
\n
\n \n A) General Dentist Bills D7210/OS bills D7250
\n B) General Dentist Bills D7251/0S Bills D7250
\n C) General Dentist sends no bill/OS Bills D7210
\n D) General Dentist Bills D7999 with a narrative /OS Bills D7250\n \n \n \n
\n
\n 15) Oral Surgeons should bill all extractions using code D7210 or higher due to being a\n Specialist. *
\n
3 points
\n
\n \n A) True
\n B) False\n \n \n \n
\n
\n 16) What attachments should be sent to support the billing of D7241?\n *
\n
3 points
\n
\n \n A) X-ray showing of apex of tooth
\n B) Narrative and/or Operative reports
\n C) A and B\n \n \n \n
\n
\n 17) If proper documents are not sent with the billing of D7210-D7241, what can the\n insurance company do?\n *
\n
3 points
\n
\n \n A) Deny payment of claim
\n B) Request additional information
\n C) Downgrade extractions for payment
\n D) All of the above\n \n \n \n
\n
\n 18) You have received an EOB downgrading tooth #1 from D7240 to D7230, what is\n your next step?\n *
\n
2 points
\n
\n \n A) Apply the payment and notify the office that patient has a remaining balance
\n B) Apply payment and adjust only for D7240
\n C) Review clinical notes. If notes support original coding,\n submit an appeal with the clinical notes\n \n \n \n
\n
\n 19) When deciding to appeal a claim, where would you find the correct address to\n send information to?\n *
\n
3 points
\n
\n \n A) Same address as original claim
\n B) Address listed on EOB
\n C) Address provided by insurance company rep for appeals\n \n \n \n
\n
\n 20) What information should an office routinely determine prior to billing codes\n D7280/D7282/D7283?\n *
\n
3 points
\n
\n \n A) Determine if procedures are covered benefits
\n B) Determine if procedures are considered Ortho Benefits
\n C) A and B\n
\n D) Nothing, knowing benefits is the patient's responsibility\n\n \n \n
\n
\n 21) What future treatment is typically required for the coverage of D7953?\n *
\n
3 points
\n
\n \n A) D2740
\n B) D4210
\n C) D6010 \n
\n D) D4266\n \n \n
\n
\n 22) The office has verified that D9223 is a covered benefit. Will the patient be covered\n for D9223 and one D7210?\n *
\n
3 points
\n
\n \n A) Yes
\n B) No
\n C) Dependent upon guidelines of Anesthesia benefits\n \n \n \n
\n
\n 23) What conditions may constitute as a Medical Necessity for Anesthesia benefits?\n (Insurance companies may vary)\n *
\n
3 points
\n
\n \n A) Physically and/or Mentally impaired
\n B) Asthma
\n C) Insulin Dependent Diabetic
\n D) All of the above\n \n \n \n
\n
\n 24) The SOAP note in a patient’s chart stands for what?\n *
\n
3 points
\n
\n \n A) It means that the clinical notes are finalized and squeaky clean.
\n B) Nothing, we do not need to read patient clinical notes
\n C) Subjective, Objective, Assessment and Plan\n \n \n \n
\n
\n 25) Billing against Medical Insurance can be an untapped revenue source for a Dental Practice\n *
\n
3 points
\n
\n \n A) True \n
\n B) False\n \n \n
\n
Use this EOB to answer the following questions
\n
\n
\n 26) By looking at this claim, would this be a dental or medical payment?\n *
\n
3 points
\n
\n \n Medical\n
\n Dental\n \n \n
\n
Please use the claim below to answer the following questions
\n
\n
\n 27) What necessary information is missing from this claim?\n *
\n
3 points
\n
\n \n A) Diagnosis Code
\n B) Date of Procedure
\n C) Tax ID
\n D) A&C\n
\n E) All of the above\n \n \n
\n
\n 28) Would you send any radiographs with this claim?\n *
\n
3 points
\n
\n \n Yes
\n No\n \n \n \n
\n
Please use the EOB below to answer the following questions
\n
\n
\n 29) Is this claim appealable?\n *
\n
3 points
\n
\n \n Yes \n
\n No\n \n \n
\n
\n 30) If so, what information would you compile or collect to write an appeal?\n *
\n
1 point
\n
\n \n \n\n
\n
Use the x-ray below to answer the following question.
\n
\n
\n 31) What would you do when you see this x-ray is the only x-ray in the patient s file\n and the claim that you have to send is for 4 - 7240s?\n *
\n
4 points
\n
\n \n A) Send claim with x-ray and see how insurance processes first
\n B) Send claim without x-ray
\n C) Call the office to clarify before sending \n
\n D) Don't see anything wrong with this x-ray\n \n \n
\n
Please use the EOB below to answer the following questions (PLEASE NOTE: Following 2 images\n are closeups of this EOB)
\n
\n
close up of above EOB
\n
\n
close up of EOB
\n
\n
\n
\n 32) What is the patient balance?\n *
\n
3 points
\n
\n \n \n \n
\n
\n 33) What is write off amount?\n *
\n
3 points
\n
\n \n \n \n
\n
Please use x-Ray below to answer the following questions
\n
\n
\n 34) You received a denial from insurance for D6010 on tooth #7. What do you see in\n the x-ray that would help you write an appeal to explain why the extraction was\n necessary and thus the implant to be placed?\n *
\n
3 points
\n
\n \n A) Abscess at root tip
\n B) Failing root canal
\n C) Largely decayed and non-restorable
\n D) Nothing visible to warrant D6010.
\n E) B and C\n \n \n \n
\n Submit\n Cancel\n
\n