Medical Billing (Adaptive*) Interview Questions & Answers

  1. Question 1. What Is The Role Of Medical Coders And Billing People In Medical Industry?

    Answer :

    The main duties of the individuals involved in the medical coding and billing job are

    • Managing and documenting the medical related paper work
    • Creating invoices regarding the bill for patients to insurance companies
    • Providing the necessary code for each procedure followed in billing system
    • Cross checking the patient’s bill coverage with relevant insurance company
  2. Question 2. Medical Billing And Coding – Question And Answers – Interview Purpose Name The Codes Used To Describe The Diagnosis?

    Answer :

    ICD -9 or International classification of diseases

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  4. Question 3. Name The Codes Which Are Involved In Procedures?

    Answer :

    Current procedural terminology or CPT

  5. Question 4. What Is The Core Purpose Of Super Bill?

    Answer :

    Super bill contains the procedures and diagnosis involved in the medical visit of patient, the biller thereafter uses this information while submitting the claim to relevant insurance player.

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  7. Question 5. What Is The Percentage Normally Allowed In The Medicare Payment?

    Answer :

    80% is the normal amount to be allowed for Medicare pay

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  9. Question 6. Which Medicare Will Generally Pay For Medical Providers In The Healthcare Services – Either Part A Or Part B?

    Answer :

    Part B will be used in the payment for medical providers in the healthcare service system

  10. Question 7. Abbreviate Tos?

    Answer :

    Type of service

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  12. Question 8. What Could Exactly Pos Stand For?

    Answer :

    Place of service

  13. Question 9. The Exact Abbreviation Of Ra In Medical Industry?

    Answer :

    Remittance Advice

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  15. Question 10. What Form Should Be Submitted For Professional Claim?

    Answer :

    HCFA – 1500 or CMS – 1500

  16. Question 11. What Is The Process Involved Under Medical Billing?

    Answer :

    • Coding (of the range – CPT, ICD -9, HCPCS)
    • Entry of patient demographics
    • All specialties wise – charge entry
    • Payment of postings (both manual and electronic)
    • Reconciliation of payments
    • Re-billing and rejection/ denial analysis
    • Follow up of accounts receivables
    • Re-billing of systemic A/R projects
    • Reporting for collection agency
    • Refund options
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  18. Question 12. What Are The Common Problems You Face In Medical Billing?

    Answer :

    • No proper supporting documentation
    • Claims are often incomplete
    • Inaccurate or lack of proper coding
    • No smooth communication with payer
    • No billing for the services being offered
    • No follow up with AR balance claims on time
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  20. Question 13. What Are The Duties Of Medical Billing Specialist?

    Answer :

    • Insurance verification
    • Patient demography and his charge entry
    • Claims submission
    • Payments posting and its process
    • Denial management
    • Insurance follow-up and management
    • Insurance appeal and its process
    • Handling inquiries under patient billing
    • Processing the patient’s statement
    • Report Preparation and management
  21. Question 14. What Are All The Certifications Involved In The Medical Billing And Coding Field?

    Answer :

    There are many certifications for the job seekers in the field of medical coding and billing. Some of them to be mentioned are

    • Certified Medical Billing Specialist ( CMBS)
    • Certified Billing and Coding Specialist ( CBCS)
    • Certified Billing Specialist – Med Certification (CBS)
    • Certified Healthcare Reimbursement Specialist (CHRS)
  22. Question 15. What Are The Types Of Medical Coding You Well Versed?

    Answer :

    Though there is a variation to the purpose of medical coding, the types are generally in accordance with the level of work experience.

    • Medical code for the analysis of medical conditions
    • Any Potential outbreak – medical code
    • Insurance reimbursement medical code

    The above are some of the well known types in medical code, there are other types which you may come across on the job. Do also learn from your colleagues and friends to acquire more information and knowledge.

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  24. Question 16. What Is The Main Use Of Cpt Codes?

    Answer :

    Mainly CPT (Current Procedural Terminology) codes are used for recording the actual level of service for each patient mentioned. Proper understanding of the codes with all its application and usage information can offer you the edge over the others.

  25. Question 17. What Is The Motivation You Receive In Medical Coding?

    Answer :

    The response is entirely open, as one may find it more rewarding, the other looks for it as more interesting, therefore the reply must be on a more apt and positive note.

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  27. Question 18. What Certifications Do You Hold?

    Answer :

    I am CPC, CHRS and CBCS certified.

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  29. Question 19. Have You Performed Billing Activities For Medicaid Or Medicare? How Was Your Experience?

    Answer :

    I have worked with both. It was interesting working with both despite the delays and the paperwork involved. Nonetheless, the experience has taught me much.

  30. Question 20. How Do You Manage Rejected Or Unpaid Claims?

    Answer :

    It is quite a problem when a claim gets rejected or is not paid. I make sure that no delays occur when submitting claims as I appreciate the fact that the longer a claim is unpaid, the less likely it is to be paid and can get rejected too. However, should this situation occur, I make sure that I correct and re-submit the claim as soon as possible.

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  32. Question 21. Have You Billed Or Coded For Any Specialties?

    Answer :

    Yes, I have. Providing coding and billing services to a mental health facility, I had to monitor number of visits and pre-authorizations.

  33. Question 22. Which Forms Have You Most Often Used In Your Current And Former Positions?

    Answer :

    I have had considerable experience with CPT, HCPCS and ICD-9 Vol 3.

  34. Question 23. Does Your Current Employer Use Emr Or Ehr?

    Answer :

    Yes. They use both.

  35. Question 24. Which Type Of Software Have You Used: Epic, Medisoft Or Other Programs?

    Answer :

    I have had extensive experience using Epic.

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  37. Question 25. Which Medicare Will Generally Pay For Medical Providers In The Healthcare Services – Either Part A Or Part B?

    Answer :

    Part B will be used in the payment for medical providers in the healthcare service system

  38. Question 26. Are You Familiar With Hipaa Privacy Rules? Security Rules?

    Answer :

    No success story required here. Just be able to give a reasonable explanation of what security and privacy standards that the billing staff is held to. The potential employer wants to know that you are familiar enough with guidelines so as to not be a liability for them in endangering or breaching confidentiality.

  39. Question 27. Have You Dealt Much With Resolving Issues With Unpaid Or Denied Claims?

    Answer :

    Dealing with patients’ payments aren’t the only places where you’ll be expected to try to “collect,” however. While dealing with patients is a large part of the job description of a medical billing specialist, it will look excellent to employers that you have experience contending against institutional bureaucracies for the sake of the practice or the sake of a better experience for patients. Detail an experience you had where you had to track down a billing error or contact insurance agencies to remove obstacles and allow a claim.

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  41. Question 28. What Is Your Experience With Patient Collections?

    Answer :

    A billing specialist will inevitably deal with patients that have missed payments. While “hard” collections go to collection agencies, “soft” collections often fall onto the shoulders of the billing specialists. What the potential employer wants to know is if you can interact with the patient with delinquent payments in a way that is gentle enough for a positive experience while still effective in procuring the missing or future payments. Relay an experience of your own when you had to contact a patient for this reason. Walk them through how you reacted to the patient, how you helped them past difficulties in paying, how you coaxed them into cooperating, or how you helped reach a compromise to ensure some sort of gain for the practice.

  42. Question 29. How Have You Dealt With Difficult Or Angry Patients?

    Answer :

    When a patient’s claim was denied or was not covered by insurance, the billing specialist will more than likely be the bearer of bad news. The practice wants to be reassured that this point of contact with the patients is as positive as possible and another opportunity to leave a positive impression of the practice. They want to know that you are patient, understanding, and able to explain to the patient exactly what happened. Reassure them of that through any experiences you’ve had dealing with difficult patients.

  43. Question 30. Do You Know How To Run Reports? Do You Know How To Customize Reports?

    Answer :

    Many practices need to run reports from their own practice management software that catalogues their patient balances, financial performance, outstanding claims, etc. Often, providers wish to see financial information about the practice in a specific format, so the ability to gather information out of a database and rearrange it into the format for the providers in a big advantage. If possible, discuss times where you have had to edit and customize the format of information to meet the needs of a specific provider.

  44. Question 31. What Type Of Certifications Do You Have?

    Answer :

    There may not be any requirement for certifications for the medical billing position, but having certifications is certainly a plus. It shows that you’re committed to your profession, and you meet certain minimum standards. If you do not have any certifications but have completed classes or been trained extensively in the field note this in your answer.

  45. Question 32. Are You Familiar With Electronic Medical Records (emr) Systems? Which Ones Have Azyou Used? How Did You Use It?

    Answer :

    Most modern billing systems are extensively integrated into EMR systems, and this is more than likely just going to increase as technology progresses. How you answer this can illustrate how up-to-date your education and experience is, as well as how effective you will be using your potential employer’s system. Your understanding of EMR systems can determine how efficient you are at cross-referencing and verifying patient or treatment information. With this in mind, when you explain how you have used it in the past, you want to highlight experiences where you have tackled a difficult task of using the EMR system to track down an obscure data point, find and correct a potentially expensive or wasteful error, helped a patient have a less stressful payment experience, or something along those lines.

  46. Question 33. Have You Billed For Medicare And Medicaid?

    Answer :

    With all of the Baby Boomers starting to enter retirement age, this kind of experience is going to be more and more relevant. Government payers can be difficult to bill, so they want to make sure that you can handle the increased complication, time, and stress for the patient that billing for CMS will bring.

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  48. Question 34. What Is Your Understanding Of Medical Finance Terminology?

    Answer :

    As a medical billing professional, you will want to have a working knowledge of different insurance and finance terms. Not only for your interview, but for your specialization you should be able to define how deductibles and co-insurance are calculated, how to apply write-offs, how to apply co-pays, etc. Demonstrate a working knowledge of how the process of medical financing works, and demonstrate that any difficulties out of your comfort zone will be few and far-between.

  49. Question 35. What Is Your Understanding Of Medical Terminology?

    Answer :

    Demonstrate your understanding medical terminology is a must in the medical billing and coding field because it ensures a streamlined process in working through patient bill processing. This is a straightforward question, but your answer can reflect your motivation to learn new material, you willingness to exert “extra” effort to be more effective at your job, and what formal training or education you have. Use this as an opportunity to describe experiences of yours where you worked above and beyond the desk hours and studied to become more grounded or more diverse in your expertise.

  50. Question 36. What Specialties Have You Billed Or Coded For?

    Answer :

    I have worked for both ophthalmologists and dermatologists and have coded and billed for both these specialties.

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  52. Question 37. Do You Know How To Run Reports? Can You Customize Reports?

    Answer :

    Since I have worked extensively with most common billing software, I am comfortable with both manual and automated reports generation processes.

  53. Question 38. Do You Know How To Submit Claims To A Clearinghouse? Have You Ever Set Up A Provider With A Clearinghouse Or Resolved Claim Submittal Issues With Them?

    Answer :

    Yes, I am familiar with claims submission procedures to clearing houses and I have resolved several claim submittal problems.

  54. Question 39. Are You Comfortable Working With Computers? What Types Of Software Do You Have Experience With?

    Answer :

    I am computer savvy. Apart from being able to work with most common software, I am familiar with IntelleChart and ECLIPSE

  55. Question 40. How Do You Deal With Rejected Or Unpaid Claims?

    Answer :

    I find out why a claim has either been rejected or left unpaid. If the insurance company has made a mistake in rejecting it, I re-file it after providing further information on why it should have been paid. If the insurance company is right in denying it, I follow up with the client in order to solicit payment.

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  57. Question 41. What’s Your Understanding Of Medical Terminology?

    Answer :

    I am comfortable with medical terminology as a whole and have extensive knowledge of terminology associated with both dermatological and ophthalmologic procedures.

  58. Question 42. Do You Think Insurance Companies Sometimes Play Games To See If They Can Avoid Paying Claims?

    Answer :

    I think they do. Not all of them and it is up to us to see who may be playing games following reputation and insight.

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  60. Question 43. Tell Me About Your Most Hostile Patient-collection Case. What Was The Problem You Encountered? Were You Able To Negotiate Payment?

    Answer :

    We had this patient whom we knew to be extremely difficult. She had a cosmetic procedure done and billed it to the agency who denied it. It was quite a horror trying to extract payment from her as she used abusive language and threatened to take us to court. We managed to negotiate payment from her by reasoning with her gently initially and then very sweetly telling her that we will take legal action. She paid three days later.

  61. Question 44. What’s Your Strategy And Process For Appealing A Denied Claim?

    Answer :

    The first thing I do is find out just why a claim has been denied. If I feel that the denial is unfair, I consult with the doctor in question and re-file the claim providing information and proof of why it should not have been denied.

  62. Question 45. Do You Have Medical-billing Certification? If Not, Are You Planning To Get Certified Or Are You In The Process Of Getting Certified?

    Answer :

    Yes, I am a Certified Billing Specialist from the AAPC