medical billing is an integral part of the health care industries. it ensures that the providers are reimbursed for the services they offer. whether a fresher or those who have experience up to 5 years, This guide would help prepare for common interview questions asked in the area of medical billing. we have segregated these into categories with answers to help clarify how to respond effectively.

Basic Medical Billing interview Questions

1. what is medical billing?

medical billing is the submission of claims with insurance companies or government departments for the reimbursement of Health care services delivered by a doctor, Hospital, or clinic. this process also encompasses collecting payment from patients And pursuance of denied or unpaid Claims.

2. what are the steps that go on in a medical billing process?

Revenue Cycle Management (RCM)

Patient registration
Insurance verification
Encounter (provider-patient interaction)
Medical coding-assigning the appropriate codes for diagnosis and procedures
Charge entry
Claims submission
Payment posting
Denial management and follow-up
Patient billing and collections

3. what is the difference between medical billing and coding?

medical billing covers remitting the claim to the payer, Waiting for an A/R receipt, And following up on denials,Whereas medical coding refers to a process in converting the medical Diagnoses and procedures into standardized Codes, Most of which are: CPT, ICD-10, or HCPCS.

4. what are CPT and ICD-10 codes?

use current Procedural terminology codes to describe and identify medical, surgical, and diagnostic services.
The ICD-10 refers To international classification of Diseases, 10th Revision, which explains diseases and Conditions

5. What is an EOB? Explanation of Benefits

an explanation of Benefits is a written explanation from the insurance company detailing the amounts billed, covered services and Any patient responsibility such As a co-pay or Deductible.
Intermediate Questions on Medical Billing

6. what is the relationship of medical billing to the revenue cycle?

medical billing is crucial as it ensures that the Healthcare provider gets paid for his services. the revenue cycle will begin at patient registration and end when the service is paid.medical billers are, therefore, saddled with the responsibility of ensuring claims, With utmost care in terms of accuracy, are submitted within the stipulated time so that they can get paid on Time.

7. What is insurance claim?

an insurance claim is An official request to an insurance company to seek reimbursement for services provided to a Patient.

8. what are accounts receivable in medical billing?

accounts receivables,Otherwise known as A/R, refer to the balances owed to the Healthcare provider for services offered But are yet to be paid by the insurance Companies or Patients.

9. What is denial management?

Denial management is tracking and managing the insurance companies' denials. It is the process wherein the cause of denial of the claim is known, and the errors were rectified, and the claim was resubmitted to successfully pay for the same.

10. What are modifiers in medical billing?

Modifiers are two-digit codes appended to a CPT code, indicating that a service or procedure was modified but not redefined. They add extra information to be sent to the payers, ensuring the correct billing.

11. What is a superbill?

It serves as a document which healthcare providers use to capture all information necessary for creating an insurance claim. The details include the patient's information, diagnosis codes, and services rendered.

12. How do you handle rejected or denied claims?

Rejected claims: These are those caught at the first stage of processing due to errors such as inappropriate details of a patient or coding. They can be corrected and submitted again.
Claims denial: Claims submitted, which the insurance company did not pay for mainly due to coverage problem or a billing problem. These demand more detail investigation, corrections, and resubmit.

13. What is HIPAA? Why does it matter in medical billing?

HIPAA Stands for health insurance portability and accountability Act.HIPAA assured that patient's Confidentiality And privacy Are maintained.medical biller should be aware of HIPAA rules and regulations Dealing With patient Information So that no penalty falls On his Head.

14. What is a clearinghouse in medical billing?

a Clearinghouse is a clearing house between the insurance companies And healthcare providers, the clearinghouse verifies that the claims sent have No errors before forwarding to the insurance company for Payment.

15. What does medical necessity mean in billing?

Medical necessity are the services or treatments that must be considered necessary for diagnosis and the treatment of a patient's condition. Claims must meet the medical necessity requirements to be paid by the insurance companies.
Questions about Advanced Medical Billing

16. what are a few of the distinctions between Medicare and medicaid?

medicare is a federal Health insurance program intended for people who are 65 years and older or others who have certain Disabilities.
medicaid actually is a joint Federal state programme,Which delivers medical benefits to needy people who are aged, blind,Disabled, or have low income.

17. what is coordination of benefits (COB)?

COB stands for coordination of benefits,which happens when a patient is under more than one insurance Plan. The medical biller would then find out which is the primary and which is the secondary so that claims are submitted properly.

18. What is your procedure when dealing with overpayments from the insurance company?

When there is an overpayment, it usually is due to the amount being paid by the insurance account exceeding the charged amount. In either of these scenarios, the overpayment should either be forwarded to the insurance company to remit it back or should be made accessible for adjustment against the patient's account.

19. Role of the Medical Billing Collector in Collecting Patient Balances

Accounts must be charged to the patient for the balance on an account when that claim has been rejected or denied by the payer. It is the responsibility of the medical billing collector to mail statements and to make follow-up contact in an effort to collect those balances. Contact payers to discuss payment plans.

20.what is a payer contract, and why is it important?

a payer contract is a mutual agreement between a healthcare provider and an insurance company.in it,the terms of reimbursement for such services as rendered are Established, including rates, services that Are covered, And timeframes for Payment.

21. how are HMO, PPO, and EPO different in terms of plans that are offered under an insurance plan?

HMO (Health Maintenance Organization): patients must select a primary care physician,And when such physician has a referral from that primary care physician Before going to see a Specialist.
PPO (Preferred Provider Organization): offers greater flexibility when selecting providers and has no specialist referral Requirements .
EPO (Exclusive Provider Organization): It's a mix of HMO and PPO in which coverage is offered only for certain services by a restricted network of providers.

22. Which of the following are some of the common reasons claim denials occur?

Some of the possible reasons include:
 
Incorrect information for the patients
Duplicate claims
Services aren't medically necessary
Services that are not covered by the plan
It hasn't been authorized

23. Why is timely filing in medical billing important?

This is where insurance companies set a certain time limit for making a claim. If this limit is not met, then the claim is not allowed.

24. how would you distinguish between a Rejection of a claim and the denial of a claim?

this is simply referred to as a fundamental mistake in submitting the claim because your patient information is incorrect,or your insurance information is incorrect, While a claim denial occurs after the claim is processed and subsequently found unpayable to the provider for any number of reasons,such as lack of coverage or not medically Necessary.

25. How do you keep abreast of updates in medical billing and coding?

They must keep pace with the ever-changing education and update themselves by going to workshops, subscribing to newsletters relevant to the industry, and tracking updates from CMS and similar bodies.

Problem Solving Questions on Medical Billing

26. What procedure when a denial occurs due to medical necessity denial?

Check that proper codes were put in the chart with a review of the medical record.
Resubmit after appealing the denial.
Contact the payer to see if further information is required for the service to be allowed.

27. What would you do if the provider's charges and the insurance payment differ?

You check the coding and charges on the claim to ensure that the two are correct in accordance with the payer's policies.
You contact the insurance company to correct any underpayments or overpayment made.
You make a change on the patient's balance if it is applicable, and you call the patient.

28. What are some ways that a high volume of claims may be handled

Effective Management comprises;
Submission of claims after meeting the payers' timeliness.
Automated claims submissions and monitoring the rejects from Clearinghouse.
Efficient submission of claims by batching them.

29. How do you check for errors on the claims you submit?

Thorough audits of claims
Pre-submission scrubbing: Identify mistakes before submitting

Collaborate with the coding group to ensure proper Dx and procedure codes

30. What would you say to a patient, who is complaining about billing errors?

To a patient, listen carefully to their concerns.
Remind them of your story and describe in detail what they are being charged for.
If there is an error correct it quickly and pass the outcome on to the patient.
Technical Medical Billing Questions

31. What software applications are commonly used in medical billing?

Some of the most commonly used software tools for medical billing include:
AdvancedMD
Kareo
Epic
Cerner
Medisoft

ECW

32. Why is claim scrubbing so crucial?

Claim scrubbing is the process where claims are checked for errors to ensure they contain no errors before submission. This usually prevents rejection and denial. Claims are cleaned and have a higher opportunity of being paid.

33. what is inpatient and outpatient billing?

inpatient billing: It deals with patients who spend over 24 hours in the hospital.the billing process is usually more complex and hence involves all components of the care provided to the patient.
outpatient billing: patients who receive treatment from outside the hospital are included in this.the billing is usually restricted to certain procedures or tests.

34. What is fee schedule in medical billing?

a fee schedule is a list of the Maximum Allowable charges for services rendered. Every insurance company has a fee schedule that defines how much will be reimbursed for which procedures.

35. what is capitation in medical billing?

capitation is a type of payment whereby the provider receives a fixed sum per patient for a specified period irrespective of the number of services Rendered.

Scenario-Based Medical Billing Questions

36. How will you deal with an underpaid claim?

Note the claim details and cross-check with the contract with the payer.
Check whether the coding or documentation was faulty.
Contact the payer for an adjustment or appeal on the basis of the underpayment.

37. What would you do in case of an angry patient who received a bill not expected?

 Stay calm and professional.
 Read the patient's bill and show him the charges.
 If there is an error in billing, apologize and correct the mistake immediately
 Agree to set up a payment plan with the patient if he cannot pay the bill at once

38. How do you prioritize claims when working under a tight deadline?

 Pay high-dollar claims first.
Place claims in the order of payer deadlines.
 Handle those that are nearing the deadline for timely filing.

39. What would you do if a claim is denied for lack of authorization?

Verify it was authorized and documented.
If not, follow up with the provider's office to get the missing authorization.
Resubmit the claim with the attached authorization.

40. What would you do if a claim is denied for being out of network?

Verify that the patient's insurance carrier is a network provider.
Contact the patient and notify them that their claim was denied and the possible choices.
File an appeal for the denial if it was due to factors beyond the patient's control or was processed improperly.
Behavioral Medical Billing Questions

41. Describe a situation in which you had to navigate with a difficult insurance representative. How did you react?

I had one insurance representative who was not cooperative when I trailed a claim. The representative kept his cool, got the details and requested that it be escalated to the supervisor. This kept him unruffled and ready to solve the issue after winning compensation from the claim.

42. Describe a situation where you realize that an error has occurred in a claim. How did you handle it?

In reviewing claims, at one time I came across a diagnostic code that was inconsistent with the procedure performed. I brought this inconsistency to their attention, corrected the code, and resubmitted it so they were paid correctly.

43. What are some general suggestions for staying organized in medical billing with a lot of paper work or tasks?

It means that I will prioritize my work with regard to the payer deadline and claim value. It is effective in my case as I utilize software like task management apps in keeping up my claims and follow-ups, so nothing falls through the crack.

44. Tell me of a time when you were able to reduce the volume of claim denials.

One of the things I had done in my previous job was to implement a claim-scrubbing process that involved reviewing a claim for common errors before it was presented or submitted. This reduced denials considerably and increased the practice's revenue significantly.

45. How would you handle a stressful situation at work?

I keep focused by breaking down task steps so that they are manageable and the most critical tasks are prioritized. I also have an open communication channel with my team to ensure everyone remains aligned, and that stress levels are kept to a minimum.

Experience-Based Medical Billing Questions

46. What is your experience working on denied claims?

I have worked with denied claims for years. I research denial reasons and correct coding errors and, when permissible, file appeals on claims. I contact insurance companies to solve problems promptly.

47. Have you ever worked with Medicare or Medicaid claims?

Yes, I have experience working with Medicare and Medicaid claims. I am familiar with specific billing rules, timely filing limits, and processes used for denial or underpayment appeals.

48. How have you minimized accounts receivable?

I have maintained follow-up schedules for claims unpaid, and that ensures stay in touch with both payers and patients. I also work on denial management and negotiate payment plans for patients as necessary.

49. Describe an experience of a difficult billing scenario you faced and how you addressed it?

There was a time where the claim denials were due to incorrect coding. I reconciled with the coding department, and when I sat down with them and went over the documents, all their codes were corrected. Then we remitted the claim, and it was processed.

50. How much do you like what you are doing in medical billing?

I really love the challenge of ensuring correct billing and reimbursement with maximum rewards for healthcare providers. I am glad to know that my work directly affects the financial health of a medical practice.

Conclusion

These 50 interview questions and answers cover a wide array of topics that may arise depending on your level of experience as a medical biller. Whether you are new or have a few years of experience, familiarity with these concepts will help you to feel confident and well-prepared for your next medical billing interview.