Question 1

A dental clinic provided by a large corporation for employees and their families is an example of what type of dental program?&#10;A)Capitation program&#10;B)Preferred provider organization&#10;C)Franchise dentistry&#10;D)Closed panel programs

Accepted Answer

A dental clinic provided by a large corporation for employees and their families is an example of a closed panel program, where the group of dentists is limited to those specifically contracted with the corporation to provide dental care to participating employees and their families. Capitation programs involve a set monthly fee to a dentist or dental plan for a specific patient population, while preferred provider organizations involve contracting with a network of dentists who agree to provide services at a discounted rate. Franchise dentistry involves a business model where one dentist or group of dentists own multiple dental offices operating under a common name and system.

Question 2

Which of the following statements is true?&#10;A)The CDT manual is published by the CRC and is updated annually.&#10;B)The first digit of a dental procedure code is the number &#34;2.&#34;&#10;C)A brief,literal definition precedes each dental procedure code.&#10;D)The CDT manual is used principally to identify and define transaction codes.

Accepted Answer

The CDT (Current Dental Terminology) manual is primarily used to identify and define dental procedure codes for billing and insurance purposes.

Question 3

Where should copies of the Explanation of Benefits (EOB)be filed?&#10;A)In the clinical records&#10;B)In a file for the month in which the claim was billed&#10;C)In a file for the specific insurance company&#10;D)In a file for the month in which the claim was paid

Accepted Answer

Copies of the Explanation of Benefits (EOB) should be filed in a file for the month in which the claim was paid, as this helps in organizing and tracking payments received for claims.

Question 4

Employers rarely change their dental coverage.A patient with the same company for 25 years will most likely have the same carrier and benefits for the duration of his/her employment.&#10;A)The first statement is true;the second statement is false.&#10;B)The first statement is false;the second statement is true.&#10;C)Both statements are true.&#10;D)Both statements are false.

Accepted Answer

The answer of Employers rarely change their dental coverage.A patient...

Question 5

A new administrative dental assistant is learning to complete insurance claims.The claim she is processing is for a minor child who is covered under dental plans from both parents' employers.She asks whether you know which plan should be billed first.Using the Birthday Rule,what would you tell your colleague?

A)The father's insurance should be billed first if he is older than his wife.
B)The parent who has a birth date closest to that of the child is billed first.
C)The parent whose birthday comes first in the year is the primary insurance holder.
D)Call the parents and ask whom they would like you to bill first.

Accepted Answer

The "Birthday Rule" states that the parent whose birthday (month and day, not year) comes first in the calendar year is the primary insurance holder for the purposes of billing. This rule is used to determine which policy is billed first when a child is covered under both parents' dental or health insurance plans.

Question 6

When the usual fee charged by the dental practice is higher than the fee established in a(n)_______,the difference between fees cannot be charged to the patient.&#10;A)fixed fee schedule&#10;B)table of allowance&#10;C)indemnity schedule&#10;D)schedule of allowance

Accepted Answer

A fixed fee schedule establishes a set fee for specific dental procedures, and if the practice charges a higher fee than the established fee, they cannot charge the patient for the difference. A table of allowance is similar to a fee schedule, but it lists the maximum amount the insurance company will pay for each service. An indemnity schedule is a type of dental insurance plan that allows patients to obtain treatment from any dental provider they choose, but it may not establish specific fees for services. A schedule of allowance is the same as a table of allowance.

Question 7

Which of the following statements is false?&#10;A)Patients with dual coverage do not get to decide who is going to be the primary carrier.&#10;B)The primary carrier is always billed before the secondary carrier.&#10;C)The gender rule assigns primary coverage to the mother when secondary coverage for children is determined.&#10;D)The secondary insurance company will not pay more than the residual balance.

Accepted Answer

The gender rule does not always assign primary coverage to the mother. It may assign primary coverage to the parent with the earlier birthdate in a calendar year or the parent with the primary custody of the child.

Question 8

Which method of payment sidesteps the insurance company by paying directly from a fund established by an employer?&#10;A)Union trust fund&#10;B)Direct reimbursement&#10;C)Capitation program&#10;D)Incentive program

Accepted Answer

Direct reimbursement is a method of payment where the employer or company pays directly for the medical expenses without involving any insurance company. This fund may be established by the employer or may be the employer's own funds. This method sidesteps insurance companies and cuts out the middleman.

Question 9

Fill in the blank: _______ is the set dollar amount that the patient must pay toward treatment before the third party will consider payment.&#10;A)Policy coverage&#10;B)The deductible&#10;C)Coverage limitation&#10;D)Eligibility

Accepted Answer

The blank is describing the concept of a deductible, which is a set dollar amount that the patient must pay out-of-pocket before their insurance coverage begins to pay for treatment. Option A (Policy coverage) relates to the overall amount an insurance policy will cover, but doesn't specifically address the patient's responsibility for paying a deductible. Option C (Coverage limitation) may refer to restrictions on certain treatments or services that are covered by insurance, but doesn't specifically address the patient's responsibility for paying a deductible either. Option D (Eligibility) refers to whether or not an individual is qualified to receive coverage under a given insurance policy, but again doesn't directly address the concept of a deductible.

Question 10

A patient states that he has dental insurance through his employer and is also covered under his wife's plan.He asks whether both plans can be used to cover the full amount of the treatment.You know that the term that describes this process is:

A)Consolidated Omnibus Budget Reconciliation Act (COBRA).
B)coordination of benefits (COB).
C)dependent coverage.
D)assignment of benefits.

Accepted Answer

The answer of A patient states that he has dental...

Question 11

Usual,customary,or reasonable charges include criteria that may be used to establish a fee schedule.A patient asks you to explain "reasonable fee." Which of the following would be a proper explanation?

A)The fee the dentist uses most often for a given dental procedure
B)Determination by a third party administrator that a particular service for a given procedure has been modified to take into consideration unusual complications
C)The fee determined by a third party administrator for actual submitted fees for specific dental services
D)Fees set by the insurance company without consideration of geographic location and demographic information

Accepted Answer

The answer of Usual,customary,or reasonable charges include criteria that may...

Question 12

A correctly completed dental claim form will contain all information requested for each data item.The administrative dental assistant can obtain this information from the:&#10;A)patient before treatment.&#10;B)patient after treatment.&#10;C)patient's clinical chart.&#10;D)member of the dental team who is providing treatment.

Accepted Answer

The answer of A correctly completed dental claim form will...

Question 13

A patient is being seen after a work-related accident in which several of his teeth were broken.How will his treatment be billed?&#10;A)To his primary insurance&#10;B)Workers' compensation&#10;C)Government assistance&#10;D)Secondary coverage

Accepted Answer

The answer of A patient is being seen after a...

Question 14

Maximum coverage can be described as:&#10;A)a set dollar amount that the patient must pay each year before insurance benefits are paid.&#10;B)the total amount a patient can be charged during a year.&#10;C)the total dollar amount an insurance company will pay during the year.&#10;D)the total dollar amount the insurance plan pays during the patient's lifetime.

Accepted Answer

The answer of Maximum coverage can be described as:&#10;A)a set...

Question 15

Of the following dental plans,which limits patients to a predetermined list of dentists?&#10;A)Managed Care Plan&#10;B)EPO Plan&#10;C)HMO Plan&#10;D)All of the above

Accepted Answer

The answer of Of the following dental plans,which limits patients...

Question 16

A teenager is new to the dental office and is filling out the new patient paperwork.When he gets to the insurance section,he asks you what he should put for subscriber.You explain that:&#10;A)he is the subscriber.&#10;B)his father is the subscriber.&#10;C)his mother is the subscriber.&#10;D)the holder of the dental benefits is the subscriber.

Accepted Answer

The answer of A teenager is new to the dental...

Question 17

Overbilling can be described as all of the following,except:&#10;A)the dentist recommends and performs and charges for unnecessary dental services.&#10;B)waiver of copayment,with third party payment accepted as full.&#10;C)the dentist increases the fee solely because the patient has insurance.&#10;D)fraudulent insurance billing.

Accepted Answer

The answer of Overbilling can be described as all of...

Question 18

A patient is in need of an expensive dental procedure.He tells you that although it would be covered at 80% now,in 1 month,it will be covered at 90% when the new benefit year begins.You know that his insurance has:

A)a fixed fee schedule.
B)an incentive program.
C)a capitation program.
D)direct reimbursement.

Accepted Answer

The answer of A patient is in need of an...

Question 19

Fill in the blank: After _______ days,review and track any unpaid dental claims.&#10;A)7&#10;B)10&#10;C)30&#10;D)60

Accepted Answer

The answer of Fill in the blank: After _______ days,review...

Question 20

The first step in processing a dental claim form is to discuss the insurance coverage with the patient,and determine the patient's portion.&#10;.

Accepted Answer

The answer of The first step in processing a dental...

Question 21

Once submitted,a paper dental claim has a turnaround time of approximately _______,while an electronically submitted claim has a turnaround of _______.&#10;A)1 week,1 to 2 days&#10;B)1 to 2 days,1 week&#10;C)1 month,7 to 10 days&#10;D)7 to 10 days,1 month

Accepted Answer

The answer of Once submitted,a paper dental claim has a...

Question 22

Match between columns&#10;                        Premises: Confirmation by a dental benefits plan that a pretreatment plan is authorized for payment&#10;Confirmation by a dental benefits plan that a pretreatment plan is authorized for payment&#10;Confirmation by a dental benefits plan that a pretreatment plan is authorized for payment&#10;Confirmation by a dental benefits plan that a pretreatment plan is authorized for payment&#10;Confirmation by a dental benefits plan that a pretreatment plan is authorized for payment&#10;Confirmation by a dental benefits plan that a pretreatment plan is authorized for payment&#10;Confirmation by a dental benefits plan that a pretreatment plan is authorized for payment&#10;Confirmation by a dental benefits plan that a pretreatment plan is authorized for payment&#10;Confirmation by a dental benefits plan that a pretreatment plan is authorized for payment&#10;Confirmation by a dental benefits plan that a pretreatment plan is authorized for payment&#10;A method of changing a reported benefits code to reflect a lower cost for the procedure&#10;A method of changing a reported benefits code to reflect a lower cost for the procedure&#10;A method of changing a reported benefits code to reflect a lower cost for the procedure&#10;A method of changing a reported benefits code to reflect a lower cost for the procedure&#10;A method of changing a reported benefits code to reflect a lower cost for the procedure&#10;A method of changing a reported benefits code to reflect a lower cost for the procedure&#10;A method of changing a reported benefits code to reflect a lower cost for the procedure&#10;A method of changing a reported benefits code to reflect a lower cost for the procedure&#10;A method of changing a reported benefits code to reflect a lower cost for the procedure&#10;A method of changing a reported benefits code to reflect a lower cost for the procedure&#10;Legal organization of dental practitioners who enter into contracts with dental benefits plans&#10;Legal organization of dental practitioners who enter into contracts with dental benefits plans&#10;Legal organization of dental practitioners who enter into contracts with dental benefits plans&#10;Legal organization of dental practitioners who enter into contracts with dental benefits plans&#10;Legal organization of dental practitioners who enter into contracts with dental benefits plans&#10;Legal organization of dental practitioners who enter into contracts with dental benefits plans&#10;Legal organization of dental practitioners who enter into contracts with dental benefits plans&#10;Legal organization of dental practitioners who enter into contracts with dental benefits plans&#10;Legal organization of dental practitioners who enter into contracts with dental benefits plans&#10;Legal organization of dental practitioners who enter into contracts with dental benefits plans&#10;Billing dental benefits plans for higher-paying procedures than services actually performed&#10;Billing dental benefits plans for higher-paying procedures than services actually performed&#10;Billing dental benefits plans for higher-paying procedures than services actually performed&#10;Billing dental benefits plans for higher-paying procedures than services actually performed&#10;Billing dental benefits plans for higher-paying procedures than services actually performed&#10;Billing dental benefits plans for higher-paying procedures than services actually performed&#10;Billing dental benefits plans for higher-paying procedures than services actually performed&#10;Billing dental benefits plans for higher-paying procedures than services actually performed&#10;Billing dental benefits plans for higher-paying procedures than services actually performed&#10;Billing dental benefits plans for higher-paying procedures than services actually performed&#10;Allowable services outlined by the third party dental benefits plan&#10;Allowable services outlined by the third party dental benefits plan&#10;Allowable services outlined by the third party dental benefits plan&#10;Allowable services outlined by the third party dental benefits plan&#10;Allowable services outlined by the third party dental benefits plan&#10;Allowable services outlined by the third party dental benefits plan&#10;Allowable services outlined by the third party dental benefits plan&#10;Allowable services outlined by the third party dental benefits plan&#10;Allowable services outlined by the third party dental benefits plan&#10;Allowable services outlined by the third party dental benefits plan&#10;Time period when a dental benefits member can select his/her provider and type of coverage&#10;Time period when a dental benefits member can select his/her provider and type of coverage&#10;Time period when a dental benefits member can select his/her provider and type of coverage&#10;Time period when a dental benefits member can select his/her provider and type of coverage&#10;Time period when a dental benefits member can select his/her provider and type of coverage&#10;Time period when a dental benefits member can select his/her provider and type of coverage&#10;Time period when a dental benefits member can select his/her provider and type of coverage&#10;Time period when a dental benefits member can select his/her provider and type of coverage&#10;Time period when a dental benefits member can select his/her provider and type of coverage&#10;Time period when a dental benefits member can select his/her provider and type of coverage&#10;Providing dental care under a common name with regional or national advertising&#10;Providing dental care under a common name with regional or national advertising&#10;Providing dental care under a common name with regional or national advertising&#10;Providing dental care under a common name with regional or national advertising&#10;Providing dental care under a common name with regional or national advertising&#10;Providing dental care under a common name with regional or national advertising&#10;Providing dental care under a common name with regional or national advertising&#10;Providing dental care under a common name with regional or national advertising&#10;Providing dental care under a common name with regional or national advertising&#10;Providing dental care under a common name with regional or national advertising&#10;The maximum amount paid for each procedure&#10;The maximum amount paid for each procedure&#10;The maximum amount paid for each procedure&#10;The maximum amount paid for each procedure&#10;The maximum amount paid for each procedure&#10;The maximum amount paid for each procedure&#10;The maximum amount paid for each procedure&#10;The maximum amount paid for each procedure&#10;The maximum amount paid for each procedure&#10;The maximum amount paid for each procedure&#10;Guaranteed dental coverage for 18 months after the loss of group benefit coverage&#10;Guaranteed dental coverage for 18 months after the loss of group benefit coverage&#10;Guaranteed dental coverage for 18 months after the loss of group benefit coverage&#10;Guaranteed dental coverage for 18 months after the loss of group benefit coverage&#10;Guaranteed dental coverage for 18 months after the loss of group benefit coverage&#10;Guaranteed dental coverage for 18 months after the loss of group benefit coverage&#10;Guaranteed dental coverage for 18 months after the loss of group benefit coverage&#10;Guaranteed dental coverage for 18 months after the loss of group benefit coverage&#10;Guaranteed dental coverage for 18 months after the loss of group benefit coverage&#10;Guaranteed dental coverage for 18 months after the loss of group benefit coverage&#10;Dual coverage patients cannot receive payment for more than 100% of the covered benefit&#10;Dual coverage patients cannot receive payment for more than 100% of the covered benefit&#10;Dual coverage patients cannot receive payment for more than 100% of the covered benefit&#10;Dual coverage patients cannot receive payment for more than 100% of the covered benefit&#10;Dual coverage patients cannot receive payment for more than 100% of the covered benefit&#10;Dual coverage patients cannot receive payment for more than 100% of the covered benefit&#10;Dual coverage patients cannot receive payment for more than 100% of the covered benefit&#10;Dual coverage patients cannot receive payment for more than 100% of the covered benefit&#10;Dual coverage patients cannot receive payment for more than 100% of the covered benefit&#10;Dual coverage patients cannot receive payment for more than 100% of the covered benefit

Accepted Answer

The Answer of Consolidated Omnibus Budget Reconciliation Act (COBRA) and is...

Question 23

Insurance companies calculate eligibility on a(n)_______ basis.&#10;A)daily&#10;B)weekly&#10;C)monthly&#10;D)annual

Accepted Answer

The answer of Insurance companies calculate eligibility on a(n)_______ basis.&#10;A)daily&#10;B)weekly&#10;C)monthly&#10;D)annual...

Question 24

How many data items must be entered to complete the ADA Dental Claim Form?

Accepted Answer

The answer of How many data items must be entered...

Question 25

Which of the following can aid the patient in billing the insurance company directly?&#10;A)A superbill&#10;B)An encounter form&#10;C)An EOB form&#10;D)A dental claim form

Accepted Answer

The answer of Which of the following can aid the...

Deck 15: Dental Insurance Processing