Billing, Insurance and Reimbursement Practice Questions
20 free Billing, Insurance and Reimbursement practice questions for the CDA. Tap an option to answer — you get instant feedback, the correct answer, and a detailed explanation for every question.
What does the term “dental billing” primarily refer to?
- A Only the patient's payment for the services rendered
- B Submitting insurance claims and billing patients
- C Marketing dental services to uninsured local patients
- D Tracking each patient's home-care compliance over time
Correct answer: Submitting insurance claims and billing patients
Dental billing includes both insurance claim submission and patient billing. It ensures the practice receives payment for services rendered.
Which coding system is used for most dental insurance claims?
- A ICD-10
- B CPT codes
- C CDT codes
- D HCPCS Level II
Correct answer: CDT codes
Dental procedures are coded with CDT (Current Dental Terminology) codes for insurance claims. This ensures standardization and accurate reimbursement.
What does a “clean claim” mean in dental billing?
- A A claim for preventive services only
- B A claim complete and accurate when submitted
- C A claim the insurer has already paid
- D A claim submitted without supporting radiographs
Correct answer: A claim complete and accurate when submitted
A clean claim carries every element the payer needs on first submission: correct patient and subscriber identifiers, accurate CDT procedure codes, tooth and surface detail, provider numbers and any required attachments. Because nothing has to be returned for correction, it moves straight to adjudication and is reimbursed on the normal cycle instead of being denied or pended.
Which of the following best describes a deductible in a dental insurance plan?
- A A fixed co-payment per visit
- B The amount paid by the patient before insurance begins to cover costs
- C The maximum lifetime benefit limit
- D The percentage the insurance pays
Correct answer: The amount paid by the patient before insurance begins to cover costs
The deductible is the annual amount the patient must pay before insurance coverage starts. It affects out-of-pocket costs.
What is a co-payment (copay) under dental insurance coverage?
- A A percentage of the bill paid by the patient
- B An annual maximum limit
- C A fixed amount paid by the patient for a specific service
- D An amount paid by insurance before coverage begins
Correct answer: A fixed amount paid by the patient for a specific service
A copay is a set fee the patient pays for each covered service. It is defined by the insurance plan rather than being a percentage of the cost.
What does coinsurance mean in the context of dental billing?
- A The insurance pays 100% of costs after deductible
- B The patient pays a percentage of the service cost after deductible
- C Patient pays a fixed fee per service
- D No payment is required by patient for that service
Correct answer: The patient pays a percentage of the service cost after deductible
Coinsurance refers to the portion of the cost (e.g., 20%) the patient pays after deductible is met, while insurance covers the remainder.
Which type of dental plan typically requires the patient to choose a primary dentist and limits reimbursement to in-network providers?
- A PPO plan
- B Indemnity plan
- C HMO plan
- D Discount plan
Correct answer: HMO plan
Dental HMO plans usually require a primary dentist referral and only cover in-network providers. These plans often have fixed copays.
What is the “annual maximum benefit” in a dental insurance context?
- A Maximum number of visits allowed per year
- B The highest reimbursable amount insurance will pay in a plan year
- C The deductible amount annualy
- D The patient’s portion of bill
Correct answer: The highest reimbursable amount insurance will pay in a plan year
The annual maximum is the ceiling on what the insurer will pay in a plan year. Once reached, the patient pays all further costs.
What is meant by “coordination of benefits” (COB) when a patient has multiple dental insurance plans?
- A Each insurer pays 100%
- B The secondary insurer pays before the primary
- C Determining which plan pays first to avoid duplicate payment
- D Patient pays half and each insurer half
Correct answer: Determining which plan pays first to avoid duplicate payment
COB ensures payment order is correct so total reimbursement does not exceed allowed cost. It prevents overpayment.
Which step comes first in the dental insurance billing process?
- A Submit claim
- B Verify patient insurance coverage
- C Post payment
- D Work the aging report
Correct answer: Verify patient insurance coverage
Insurance verification must come before treatment is rendered. It ensures the patient’s plan is valid and prevents claim denials.
Why is accurate documentation of completed procedures essential for reimbursement?
- A It reduces treatment time
- B To justify the services and correct coding for the claim
- C To increase patient satisfaction
- D To allow future discounts
Correct answer: To justify the services and correct coding for the claim
Proper documentation supports accurate coding and compliance with payer requirements. Errors can lead to denials or underpayment.
If a dental claim is denied by the insurer, what should the dental office do first?
- A Bill the patient immediately
- B Ignore the denial
- C Review the reason, correct errors, and resubmit if appropriate
- D Change the procedure codes
Correct answer: Review the reason, correct errors, and resubmit if appropriate
Reviewing and correcting errors helps to appeal denials and secure payment. It is a key part of effective claims management.
Which reimbursement method do many dental practices use for faster payment after services provided?
- A Cash only
- B Insurance claim submission and patient billing
- C Monthly subscription model
- D Barter system
Correct answer: Insurance claim submission and patient billing
Most practices rely on billing both insurance and patients to ensure they are reimbursed properly. This supports steady cash flow.
Which of the following can cause delays or denials in dental insurance reimbursement?
- A Timely and accurate claim submission
- B Use of correct CDT codes and documentation
- C Submitting an incomplete or incorrect claim
- D Verifying insurance eligibility before treatment
Correct answer: Submitting an incomplete or incorrect claim
Incomplete or incorrectly coded claims are common reasons for denial or payment delays. Accuracy is critical.
What is the purpose of pre-treatment estimate (pre-authorization) in dental insurance?
- A To formally guarantee the patient's comfort during the procedure
- B To estimate the insurer's payment and the patient's share
- C To schedule future maintenance and recall visits in advance
- D To serve as a legal replacement for the standard claim form
Correct answer: To estimate the insurer's payment and the patient's share
Pre-authorization gives a projected cost breakdown. This helps patients understand their financial responsibility before treatment.
How soon after treatment should a dental office ideally submit an insurance claim?
- A Within 1–2 business days
- B After 6 months
- C At the end of the year
- D Whenever convenient
Correct answer: Within 1–2 business days
Prompt submission helps ensure timely payment and avoids missing filing deadlines. Early submission increases revenue cycle efficiency.
Which type of dental plan typically allows patients to choose any licensed dentist but offers lower reimbursements for out-of-network providers?
- A Dental HMO
- B Dental PPO
- C Indemnity plan
- D Dental discount plan
Correct answer: Dental PPO
PPO plans let patients choose any licensed dentist but reduce coverage for out-of-network providers, unlike HMOs that restrict patients to a network.
Why is it considered fraudulent for a dentist to waive the patient’s co-payment without insurer approval?
- A It automatically increases the insurance premiums charged to the patient
- B The insurer pays assuming copay was collected, so waiving misstates cost
- C It provides an overly generous benefit that harms the practice financially
- D It is generally permitted whenever the patient states they cannot afford it
Correct answer: The insurer pays assuming copay was collected, so waiving misstates cost
Waiving copays misrepresents the cost shared by the patient. Insurance coverage assumes copay is paid, so waiving it constitutes fraud.
What is a dental discount plan as an alternative to traditional insurance?
- A A prepaid plan with no limits
- B A membership-based plan offering reduced fees instead of insurance reimbursement
- C A government-funded dental plan
- D A plan that only covers preventive care
Correct answer: A membership-based plan offering reduced fees instead of insurance reimbursement
Dental discount plans provide negotiated fees at reduced cost rather than reimbursements. They are an option for those without traditional coverage.
Which documentation is essential to include when submitting a dental insurance claim for reimbursement?
- A Patient diet history
- B Proper CDT codes, patient information, and service date
- C Staff lunch schedule
- D Previous appointment history only
Correct answer: Proper CDT codes, patient information, and service date
Accurate coding, patient info, and treatment date are required for claim processing. Missing details can result in claim denial.