AR/Billing Knowledge Assignment Section 1: Basic AR/Billing Knowledge 1. What does AR stand for in medical billing? 2. Which form is used to submit professional medical claims? 3. Which payer is considered primary when the patient has both Medicare and employer insurance? 4. What is the standard time frame for claim submission to Medicare? 5. What is a clearinghouse in medical billing? Section 2: Denial Management & Follow-Up 6. What is the common reason for denial code CO-11? 7. What is the best follow-up action for a CO-29 denial? 8. If a claim is denied as 'duplicate', what should be checked? 9. What is a reconsideration request? 10. How often should AR follow-up be done for claims > 60 days? Section 3: Payment Posting & Adjustments 11. If Medicare allows $80 and pays $60, and patient paid $20, what is the adjustment? 12. What does the code 'PR-1' on an EOB indicate? 13. What is the meaning of contractual adjustment? 14. What tool can be used to verify if a CPT is billable to Medicare? 15. If a patient is overcharged, how should it be corrected? Section 4: CPT, ICD, and Modifiers 16. What is the purpose of modifier 25? 17. CPT code 99214 refers to which type of service? 18. Which ICD-10 code category represents diabetes? 19. Modifier 59 is used when: 20. What is an NPI number? Section 5: Scenario-Based 21. A claim is underpaid; payer allowed $100, paid $50. Patient paid $20. What's wrong? 22. You notice repeated denials for same CPT. First step? 23. If TFL (Timely Filing Limit) is missed, what can be done? 24. A claim is denied CO-45. What does it mean? 25. Patient's insurance changed but billing sent to old plan. Next step? Section 6: Soft Skills & Communication 26. How should you communicate a denied claim to a provider? 27. What's the key to reducing AR aging > 90 days? 28. What tone should you use in payer calls? 29. If patient calls about a balance they don't understand, what's your role? 30. Why is documentation important in AR follow-up?