Question 1

What is medical billing?

Accepted Answer

Medical billing is the process of submitting and following up on claims with health insurance companies to receive payment for services provided by a healthcare provider.

Question 2

What are CPT codes and why are they important?

Accepted Answer

CPT (Current Procedural Terminology) codes describe the services provided. These codes must be accurate for proper reimbursement.

Question 3

What is the difference between eligibility and authorization?

Accepted Answer

Eligibility checks if the client has active insurance coverage. Authorization is approval from the payer to provide specific services under certain conditions.

Both are required before services begin to ensure reimbursement.

Question 4

What is the billing process?

Accepted Answer

Verify eligibility & obtain authorization.
Provide the service.
Document services and progress.
Submit claims using correct codes and modifiers.
Follow up on denials or rejections.
Post payments and address outstanding balances.

Question 5

What are billing modifiers?

Accepted Answer

Modifiers give extra information about a service provided. Common examples:
95: Telehealth
GT: Synchronous telecommunication
59: Distinct procedural service
HN/HO: Indicates provider level (Bachelor’s or Master’s)

Question 6

Why do claims get denied?

Accepted Answer

Common reasons:
Incorrect/missing codes or modifiers
Services not authorized
Patient not eligible on date of service
Timely filing limits missed
Documentation issues

Question 7

How often should authorizations be checked?

Accepted Answer

At least monthly. Always verify expiration dates and number of approved units/sessions.

Question 8

What is the difference between rejection and denial?

Accepted Answer

Rejection: Claim never entered the payer’s system (fix and resubmit).

Denial: Payer processed the claim but refused to pay (requires appeal or correction).

Question 9

What documentation is needed to support billing?

Accepted Answer

Progress notes (daily/session-based)
Treatment plans
Supervision notes (ABA)
Evaluation reports
Parent signatures (as required)

Question 10

How long does it take to get paid?

Accepted Answer

Typically:
Private insurance: 15–45 days
Medicaid: 30–90 days
Cash pay: At time of service or within billing cycle

Question 11

What systems or platforms are used for billing?

Accepted Answer

Practice management systems: 
CentralReach
WebABA
SimplePractice
Fusion

Clearinghouses: 
Availity
Office Ally

EHRs: 
Athena
Kareo
TherapyNotes

Question 12

What is the importance of accurate data entry?

Accepted Answer

Errors in client info, diagnosis codes, or provider NPI can lead to denials, compliance issues, and lost revenue.

Question 13

Do all services need to be authorized?

Accepted Answer

Depends on the payer. Some allow initial sessions or evaluations without prior authorization. Always confirm with payer-specific policies.

Question 14

Can services be billed if documentation is missing?

Accepted Answer

No. Services must be documented appropriately to meet compliance standards and payer requirements.

Question 15

What should I do if a claim is denied?

Accepted Answer

Review the denial code/reason
Correct the issue (e.g., add modifier, resubmit with proper documentation)
File an appeal if necessary
Track follow-up

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