RCM

HIIPA

Authorization eligibility

Payment posting

Medical claim

Medicare

Madicaid

Valid authorization

Claim denial

Medical Terminology

Patient demographics and Insurance details

Payment Posting – Process Charges , Payment, Denial and adjustment

Patient Billing Inquires and Problems

Authorization

Dental Billing

Benefit Verification

Authorization verification

Pre Authorization

Post pay

Prepaid

Post pay authorization

Pre pay authorization

Clearing House

Job Description:

 Review and verify the patient’s information against insurance company specifications
through site

 Maintaining documentation files with patient demographic and insurance details

 May enter data electronically to process charges, payments, denials and adjustments

 Resolve routine patient billing inquiries and problems, follow up on balances due from
insurance companies through Interactive Voice Response IVR/ Customer Service
Representative CSR
Job Requirements:

 Educational Qualification: Graduate with any discipline

 Should have excellent communication and interpersonal skills

 Knowledge of medical terminology will be considered as additional advantage

 Schooling done from English Medium preferred

 Excellent in English communication (written and spoken)

Medial Billing Question and Answer

1. What is medical billing?

Medical billing is the process of translating healthcare services rendered by a provider into a billing
claim. This claim is then submitted to insurance companies for payment. The process involves several
steps, including patient registration, verification of insurance, coding of services, claim submission,
and follow-up on any denied claims.

Example Answer: "Medical billing is the backbone of the healthcare revenue cycle. It involves
translating healthcare services into billing claims, which are then submitted to insurance companies
for reimbursement. This process ensures that healthcare providers are paid for their services and can
continue to offer quality care to patients."

2. What are the primary responsibilities of a medical biller?

A medical biller's primary responsibilities include verifying insurance coverage, coding medical
procedures accurately, submitting claims to insurance companies, following up on unpaid claims, and
managing patient billing inquiries. Medical billers also ensure compliance with healthcare regulations
and work to resolve any discrepancies in billing.

Example Answer: "The primary responsibilities of a medical biller involve verifying patient insurance,
accurately coding medical procedures, and submitting claims to insurance companies. Additionally,
they follow up on unpaid claims, handle patient billing inquiries, and ensure all billing practices
comply with current healthcare regulations."

5. How do you handle claim denials?

Claim denials are a common challenge in medical billing, and effectively managing them is vital for
maintaining cash flow and ensuring providers are paid for their services. Handling denials involves
identifying the reason for the denial, correcting any errors, and resubmitting the claim or appealing
the decision.

Example Answer: "When handling claim denials, I first identify the reason for the denial by reviewing
the Explanation of Benefits (EOB) or remittance advice. I then correct any errors, such as incorrect
coding or missing information, and resubmit the claim. If necessary, I follow up with an appeal,
providing additional documentation to support the claim. My goal is always to resolve denials quickly
and efficiently to minimize disruptions in revenue."
6. What is the difference between HMO and PPO insurance plans?

Understanding the differences between various insurance plans is essential for medical billers to
navigate coverage rules and billing requirements. Health Maintenance Organizations (HMOs) and
Preferred Provider Organizations (PPOs) are two common types of insurance plans, each with its own
structure and implications for billing.

Example Answer: "HMO plans typically require patients to choose a primary care physician (PCP) and
get referrals for specialist care, which can limit the providers they can see. PPO plans, on the other
hand, offer more flexibility, allowing patients to see any healthcare provider without a referral,
though staying within the network usually results in lower out-of-pocket costs. Understanding these
differences helps ensure that billing is handled correctly according to the plan's requirements."

7. Can you describe your experience with electronic health records (EHR) systems?

Electronic Health Records (EHR) systems are integral to modern medical billing, streamlining the
process of recording patient information and ensuring that billing is accurate and efficient. Your
experience with these systems can demonstrate your ability to navigate and utilize digital records
effectively.

Example Answer: "In my previous role, I worked extensively with EHR systems like Epic and Cerner. I
used these systems to input patient information, verify insurance details, and ensure that all
documentation was accurate and up to date. This experience has helped me become proficient in
managing electronic records, reducing errors, and improving the efficiency of the billing process."

9. What steps do you take to ensure patient confidentiality?

Patient confidentiality is a critical aspect of medical billing, governed by regulations such as HIPAA
(Health Insurance Portability and Accountability Act). Ensuring that patient information is kept
confidential and secure is paramount in maintaining trust and compliance with legal standards.

Example Answer: "I take patient confidentiality very seriously and adhere strictly to HIPAA
guidelines. I ensure that all patient records are accessed only by authorized personnel and use
secure, encrypted systems for storing and transmitting information. Additionally, I avoid discussing
patient details in public areas and ensure that all physical documents are stored in locked cabinets
when not in use. Regular training and staying updated with the latest privacy regulations also help
me maintain the highest standards of confidentiality."

13. How do you ensure compliance with healthcare regulations?

Compliance with healthcare regulations, such as HIPAA, is critical in medical billing. Demonstrating
your commitment to compliance shows that you take legal and ethical standards seriously.

Example Answer: "To ensure compliance with healthcare regulations, I stay informed about the
latest updates and changes in laws like HIPAA. I regularly participate in training sessions and webinars
to keep my knowledge current. Additionally, I implement strict protocols for handling patient
information, use secure systems for data management, and conduct regular audits to ensure all
processes meet regulatory standards."

Specialties We Serve:
- Chiropractic - Physical Therapy
- Lab Billing - Dental
- Cardiology - Orthopedic
- Internal Medicine - Family Medicine
- Infectious Disease - Acupuncture
- DME - Podiatry
- Optometrist - Radiology
- Oncology - Pharmacy Billing

DENIAL MANAGEMENT SERVICES

CREDENTIALING SERVICES

PRACTICE ANALYTICS SERVICES

Account payable

Payroll services

EMR/PM Software Development

 Eligibility and Claims Gateway

 Real time and batch Medicare, Medicaid, and commercial eligibility processing

 X12N transaction clearing and translation

 Reporting services

 Online remittance advice/EOBs

 Web data exchange

 Transaction management tools