Dental Insurance Processing Study Guide
Questions
Course Introduction
Dental Insurance Processing covers the fundamental principles and practical skills necessary to manage dental insurance claims in a clinical setting. Students will learn about different types of dental insurance plans, including private, group, government, and managed care, as well as essential terminology and coding systems such as CDT. The course emphasizes accurate claim preparation, submission procedures, verification of benefits, pre-authorizations, and handling claim denials or appeals. Students will gain proficiency in using dental practice management software to streamline the insurance process and ensure compliance with privacy regulations, all while effectively communicating with both patients and insurance providers.
Recommended Textbook
The Administrative Dental Assistant 3rd Edition by Linda J Gaylor
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18 Chapters
430 Verified Questions
430 Flashcards
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Chapter 1: Orientation to the Dental Profession
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22 Flashcards
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Sample Questions
Q1) Health Insurance Portability and Accountability Act of 1996 (HIPAA): The title of the act contains two major sections: Portability and Accountability.The Portability section of the Act guarantees that:
A)electronic transactions and code sets can be used to transmit patient information.
B)protected health information (PHI)must be protected in all formats and in all locations;this includes the transfer of information in oral,written,and electronic formats and when stored (paper and electronic copies).
C)a person covered by health insurance by one employer can obtain health insurance through a second employer if he or she changes jobs.
D)patients have to sign a specific authorization before a covered entity can release their medical information to a life insurer,a bank,a marketing firm,or another outside business for purposes not related to their healthcare.
Answer: C
Q2) The acronym PHI stands for ______,in regard to the Privacy Rule as set forth by HIPAA.
Answer: Protected Health Information
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Chapter 2: Dental Basics
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Sample Questions
Q1) What type of tissue forms the gingivae,hard palate,and dorsum of the tongue?
A)Masticatory mucosa
B)Smooth muscle
C)Palatine raphe
D)Incisive papilla
Answer: A
Q2) OSHA has mandated that scrubs or uniforms worn during dental treatment cannot be worn outside the dental office.The dental assistant is responsible for bringing the contaminated clothing home to have it laundered.
A)The first statement is true;the second statement is false.
B)The first statement is false;the second statement is true.
C)Both statements are true.
D)Both statements are false.
Answer: A
Q3) The live cellular substance of the tooth is known as:
A)gingivae.
B)cementum.
C)enamel.
D)dentin.
Answer: D
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Chapter 3: Communication Skills and Telephone Techniques
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20 Flashcards
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Sample Questions
Q1) The communication process consists of five elements.Which element is responsible for providing feedback?
A)Sender
B)Medium
C)Message
D)Receiver
Answer: D
Q2) In effective communication,the sender of the message is responsible for _______.
A)selecting the best medium for the message
B)listening to the complete message
C)initiating feedback
D)completing the message transfer before changing the subject
Answer: A
Q3) A patient who covers his/her mouth most likely is communicating which non-verbal message?
A)Tenseness
B)Anger
C)Fearfulness
D)Embarrassment
Answer: D
Page 5
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Chapter 4: Written Correspondence
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25 Flashcards
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Sample Questions
Q1) Of the following types of patient correspondence,which may be prohibited by the state dental board's legal and ethical regulations?
A)Welcome to Our Practice
B)Introduction of a New Associate
C)Direct Mail Promotion
D)Thank You for New Patient Referral
Q2) Written correspondence in the dental office includes all but which of the following?
A)Business letters
B)Monthly newsletters
C)Patient brochures
D)Purchase orders
Q3) Success in handling incoming mail is measured by _______.
A)how quickly and accurately the mail is routed
B)how efficiently payments are processed
C)how soon mail is answered
D)all of the above
Q4) A _______ is a light mark on professional stationery that identifies the type or manufacturer of the paper.
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Chapter 5: Patient Relations
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Sample Questions
Q1) According to Maslow's Hierarchy of Needs,_______ is pursued only once all other needs have been met.
A)self-actualization
B)self-esteem
C)love
D)shelter
Q2) Infection control is an expectation of all patients.How can the dental staff ensure that controls are in place and that they are being protected?
A)Post a sign in the restroom stating that all employees are to wash hands before returning to work.
B)After opening sterilized instruments,leave the wrapper on the tray so the patient will know that sterile instruments are being used.
C)Inform the patient of the process and steps you take in the office to comply with standard precautions.
D)Provide red sharps containers in each treatment room.
Q3) Patients who must wait longer than ______ should be given options to make the wait more comfortable.
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Chapter 6: Dental Healthcare Team Communications
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22 Flashcards
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Sample Questions
Q1) Conflict can be constructive if:
A)it helps team members find new ways to state their problems.
B)it increases resistance to change.
C)it reduces communication.
D)it produces an atmosphere of cynicism.
Q2) Which type of intraorganizational conflict occurs when two dental assistants disagree?
A)Intrapersonal conflict
B)Interpersonal conflict
C)Intergroup conflict
D)Intragroup conflict
Q3) Which of the following should be implemented after a staff meeting?
A)Notes should be typed and distributed.
B)The type (formal or informal)of meeting should be identified.
C)Each team member should be given an opportunity to voice opinions.
D)An agenda should be developed.
Q4) When an individual is assigned a task that does not satisfy his/her personal goals,values,beliefs or expertise,he/she may experience ______ conflict.
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8
Chapter 7: Computerized Dental Practice
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22 Flashcards
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Sample Questions
Q1) The ______ is a unique identification number for healthcare providers that is required on all electronic transactions.
Q2) A computerized account identifies _______.
A)the person receiving dental treatment
B)the person who is financially responsible for paying the account
C)the legal guardian or head of household
D)the patient's insurance company
Q3) What should you do if the computer system goes down?
A)Cancel all patient appointments until the system is up and running.
B)Ask patients to wait in the reception area until the system is up and running.
C)Use the "honor system"-upon completion of treatment,ask patients to return to the office at their earliest convenience to complete the transaction (schedule appointments,pay for services rendered,etc. ).
D)Record transactions in a daily journal,and enter the data when the system is up and running.
Q4) More than one patient can be assigned to an account.
A)True
B)False
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Chapter 8: Patient Clinical Records
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Sample Questions
Q1) What is the most important reason why complete medical history is taken before dental treatment is provided?
A)It should not be taken because it violates the patient's confidentiality.
B)So the dentist will be aware of any medication the patient is taking
C)Because the patient's medical doctors are reluctant to release information to a dental office
D)Careful review of medical history will alert the dentist to possible interactions between dental and medical treatment.
Q2) Which of the following describes the Equivalent Requirements for Government?
A)State that the provisions of the Privacy Rule generally apply equally to private sectorand public sector-covered entities
B)Indicate that law enforcement activities are limited
C)Are concerned that oversight of the healthcare system is provided
D)Ensure that judicial and administrative proceedings are completed
Q3) The key elements of record keeping include organization,completeness,and:
A)accuracy.
B)consistency.
C)neatness.
D)accessibility.
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Page 10
Chapter 9: Information Management
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Sample Questions
Q1) Which HIPAA rule covers the protection of all PHI in paper form?
A)HIPAA Security Rule
B)HIPAA Privacy Rule
C)HIPAA Patient Confidentiality Rule
D)HIPAA Security Gatekeeper Rule
Q2) Within the dental practice,most filing is done _______.
A)according to subject
B)alphabetically
C)chronologically
D)geographically
Q3) Aging labels are designed to:
A)designate the patient's age.
B)identify patients who qualify for Medicare insurance.
C)allow for easy identification of when a patient was last seen.
D)identify when labels are old and need to be replaced.
Q4) When a file is removed from the system,what should be left in its place?
A)A guide
B)An out-guide
C)Numeric indexing
D)It is not necessary to leave anything in its place.
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Chapter 10: Dental Patient Scheduling
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Sample Questions
Q1) In which of the following scenarios is appointment confirmation essential?
A)The patient calls for an appointment.
B)The patient is present in the dental office and needs a follow-up appointment.
C)The patient schedules an appointment through a Web-based program.
D)The patient preschedules an appointment at the conclusion of a recall appointment.
Q2) Pages of the appointment book are divided into _______.
A)rows
B)columns
C)bullets
D)paragraphs
Q3) What is the major advantage of a loose leaf appointment book?
A)It can be folded back on itself to preserve space on the desk.
B)It can be stored easily.
C)New pages can be inserted for a smooth transition from year to year.
D)It is less costly than a hardbound book.
Q4) Appointment books contain protected health information (PHI)and must be kept out of sight.
A)True
B)False
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Chapter 11: Recall Systems
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Sample Questions
Q1) Patients may get frustrated and seek another dentist if they cannot schedule an appointment within ______.
Q2) Which of the following statements is true?
A)The telephone recall system provides immediate feedback about the needs of the patient.
B)The telephone recall system combines all components of an effective recall system into one seamless function.
C)The telephone recall system relies on patients' taking the initiative to call and schedule an appointment.
D)The telephone recall system requires patients to schedule their next appointment before they leave the office.
Q3) The _______ uses a database to identify and track recall patients,saving the dental practice time and money.
A)prescheduled recall system
B)telephone recall system
C)automated recall system
D)mail recall system
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Chapter 12: Inventory Management
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Sample Questions
Q1) Which of the following statements is false?
A)Major equipment information can be organized for quick reference with an index card file.
B)Purchasing major equipment is time-consuming.
C)Major equipment is usually purchased directly from the manufacturer.
D)Members of the dental team can try different models of equipment at trade shows or dental conventions.
Q2) Determining when to reorder involves two factors: rate of use and lead time.Which of the following statements defines lead time?
A)Length of time it takes to produce the item ordered
B)How much of the product is used in a specified period
C)Amount of time required for supplies to arrive at the office once the order has been placed
D)Amount of time added to the expected delivery date,so the office does not run out of supplies
Q3) The acronym OSHA stands for ______.
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14
Chapter 13: Dental Office Equipment
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Sample Questions
Q1) What piece of computer equipment is needed to electronically transfer information through a transmission line to another location?
A)Central processing unit
B)Scanner
C)Modem
D)Keyboard
Q2) Which of the following is the most common input device?
A)Keyboard
B)Scanner
C)Modem
D)External drive
Q3) Which of the following statements is true?
A)A headset allows communication between a computer and a telephone.
B)Use of a headset reduces neck muscle strain.
C)Headsets are not practical in the dental office setting.
D)All headsets are attached to the base of a telephone with a long cord.
Q4) A ______ weighs and calculates the correct postage for outgoing mail.
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15
Chapter 14: Financial Arrangements and Collection
Procedures
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Sample Questions
Q1) All of the following are elements of a financial policy,except:
A)community standards.
B)practice philosophy.
C)business principles.
D)copayment levels.
Q2) Credit card payments for dental services are considered to be a(n):
A)extended payment plan.
B)flexible payment plan.
C)delayed payment.
D)cash payment.
Q3) Fill in the blank:
One advantage of a/an _______ is that an external agency assumes the risk for collecting the charges.
A)outside payment plan
B)divided payment plan
C)credit card payment
D)both A and C
Q4) Accounts are considered current if the patient has not received the first statement and the money has not been owed for longer than _______.
16
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Chapter 15: Dental Insurance Processing
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Sample Questions
Q1) The first step in processing a dental claim form is to discuss the insurance coverage with the patient,and determine the patient's portion.
A)True
B)False
Q2) 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.
A)fixed fee schedule
B)table of allowance
C)indemnity schedule
D)schedule of allowance
Q3) Insurance companies calculate eligibility on a(n)_______ basis.
A)daily
B)weekly
C)monthly
D)annual
Q4) How many data items must be entered to complete the ADA Dental Claim Form?
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Chapter 16: Bookkeeping Procedures: Accounts Payable
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Sample Questions
Q1) Fill in the blank: It may take up to _______ days for a check,sent by mail,to be received and processed.
C)10
D)30
Q2) Insurance companies commonly _______ in a practice called direct deposit.
A)deposit funds through an ATM
B)transmit information to the bank through scanned images of a check
C)take funds to the bank to have them physically deposited in the dental practice bank account
D)transfer money directly from their bank account to the dental practice bank account
Q3) Which of the following statements is true?
A)Married employees can share a payroll record.
B)Payroll and personnel records should be kept in the same file.
C)Personnel records are confidential.
D)A copy of the employee's social security card can be kept in the employee's personnel record.
Q4) How long must payroll records be kept?
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Chapter 17: Bookkeeping Procedures: Accounts Receivable
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Sample Questions
Q1) The administrative dental assistant should pull patients' clinical records,confirm appointments,and prepare the daily schedule _______.
A)a week in advance
B)the day before treatment
C)before patients arrive
D)as patients arrive
Q2) Why is an audit report necessary?
A)It is used to report business,income,and payroll taxes.
B)It identifies mistakes so they can be Corrected.
C)It protects the employer against embezzlement.
D)Both B and C
Q3) All the following are components of the financial record,except:
A)patient information.
B)responsible party.
C)insurance coverage.
D)treatment plans and associated costs.
Q4) _______ are used to illustrate different financial and patient trends.
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Chapter 18: Employment Strategies
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Sample Questions
Q1) The interview process consists of three parts: preparing for the interview,responding to questions during the interview,and the optional follow-up with a thank you note or letter.
A)True
B)False
Q2) You are considering the advantages of working in a small dental practice.Which of the following is an advantage of a small practice?
A)Networking
B)Cross-training in business office and clinical skills
C)Increased opportunity for advancement
D)Greater number of choices in benefits package
Q3) When writing the highlights of your qualifications,what type of sentence structure should you use?
A)Use lots of descriptive adjectives.
B)Begin sentences with the pronoun "I."
C)Begin sentence with an action verb.
D)Use sentence fragments instead of complete sentences.
Q4) What is an employment agreement?
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