Medical Billing Interview Questions 2021

1) What is Medical Coding?
Medical coding professionals provide a key step in the medical billing process. Every time a patient receives professional health care in a physician’s office, hospital outpatient facility or ambulatory surgical center (ASC), the provider must document the services provided. The medical coder will abstract the information from the documentation, assign the appropriate codes, and create a claim to be paid, whether by a commercial payer, the patient, or CMS.

2)- What are the three ways to organize bill paying?
1.Paper
2. Folder or Binder
3. Digital Bill Paying

3)- What are medical billing codes?
Medical billers take the coded medical record, and bill the insurance company. Medical billers work in doctors’ offices, clinics, and hospitals. It is possible for a medical biller to work at home as well. If you enjoy working in front of a computer, data entry, and keeping up with the latest health insurance rules and regulations, then this would be a great career choice for you.

4)- What is a “J” code in medical billing?
A J Code is part ot the HCPCS Code Set and represents a medicinal substance for billing and reporting purposes. For example, if a patient receives a shot of local anesthetic for pain, the drug would be reported using a J code – that is a J followed by four numbers JXXXX.

5)- What is medical billing code 045.00?
ICD 9 Cm Code 045.00- Acute paralytic poliomyelitis specified as bulbar, poliovirus, unspecified type.

6)- What are the pros and cons of medical billing and coding? 

Advantages : 

Higher Collection Rate: Because medical coding and billing is our area of expertise, we have a higher collection rate than physicians, clinics, groups, and hospitals who attempt collections on their own. In fact, our collection rate of 99.7%, which is one of the best in the industry. 

Faster Collection Rate: In an era in which banks have virtually stopped lending money and cash flow is key, the speed with which you collect money can dramatically affect the operations of your medical practice. We collect money in an average of 22 days. 

 Less Headaches: With ICD-9-CM, there are 17,000 medical billing codes, a number that’s expected to rise to 140,000 in October 2013, when ICD-10 is implemented. The complexities of medical billing and coding grow by the day, and if you use Clinic Service, you won’t have to worry about any of that. On a weekly basis, we monitor changes in healthcare laws and regulations, and we also update our proprietary EMR and EHR software as needed (and never charge you for those updates). 

Less Overhead: To perform your own medical coding and billing effectively, you’ll need to hire a trained specialist and pay a fixed cost of salary and benefits, regardless of the ups and downs of your business. You’ll also need to invest upwards of $40,000 in EMR /EHR (Electronic Medical Records / Electronic Health Records) and medical billing software. When you partner with us, there is no overhead or prohibitive upfront fees. 

More Money In Your Pocket: Even factoring in the percentage that we charge on the money we collect for you, you’ll still come out way ahead at the end of the year. We’ll bill higher fees (thanks to our accurate coding), and we’ll collect higher percentages 

Disadvantages:
Change Is Unsettling: Any major change that you make in your medical practice has the potential to backfire, making a bad situation worse. Outsourcing your medical billing will require a change in your employees’ duties, new software, and different processes. At Clinic Service, we understand what a big undertaking this can be, and we have the professionalism and experience to help make the move as smooth as possible.

Loss Of Control: If you’re accustomed to controlling all of the variables in your medical practice and walking across the office and speaking to the person in charge of medical billing, switching to an outside company can seem like an enormous shift. At some point, though, you may want to acknowledge that medical billing isn’t your core competency or interest, and that it’s time to take a leap of faith and hire a company. At Clinic Service, we have over 40 years experience in medical billing, and we’ll be there to take care of you when you’re ready to make that leap.

Privacy Concerns: You may be struggling with medical billing, but are holding onto it because you’re embarrassed about your financial situation and/or concerned about privacy issues. We can assure you that you’re not alone in this. Many physicians, clinics, and groups that hire us to perform their medical billing are in a tight spot, with mild to severe cash flow issues.  We can provide the same service for you as we’ve done for them – work with you closely to make the changeover as painless as possible and improve your cash flow as quickly as possible. 

 

7)- What are the types of medical billing coding systems specific to health care?
Diagnostic codes,
Pharmaceutical codes,
Topographical codes
Are types of medical coding. Diagnostic codes  are used to determine decease, pharmaceutical codes are used for  identifying medicines. Medical coders will convert the notes of  physician into appropriate codes.

8)- In medical terms, which is more serious: a code red or a code blue?
There are no standard definitions or conventions for the use of “Code” designations. While “Code blue” does refer to a cardiopulmonary arrest at many hospitals, it doesn’t necessarily mean the same thing everywhere.

9)- Which type of software have you used?
Epic

10)- What is principal diagnosis?
The principal diagnosis is defined as the condition, after study, which occasioned the admission to the hospital.

11)- What do you understand by modifier in medical coding?
A modifier is a code that provides the means by which the reporting physician can indicate that a service or procedure that has been performed has been altered by some specific circumstancesbut has not changed in its code. 

12)- What is ICD-10-AM, ACHI and ACS? 
The International Classification of Diseases (ICD) is published by the World Health Organisation (WHO) for worldwide use in translating the narrative descriptions of diseases, injuries and procedures contained in medical records into alphanumeric codes
In Australia the classification system is ICD-10-AM, ACHI and ACS (International Classification of Diseases 10th revision Australian Modification Australian Classification of Health Interventions and Australian Coding Standards)
The National Casemix and Classification Centre (NCCC) is the Australian body which prepares, updates and publishes new editions of the coding volumes in book and electronic format.

13)- What is a clinical coder? 
Clinical coders convert information from a patient’s medical record into alphanumerical codes according to a health classification system. The health classification system used in Australia is the International Classification of Diseases 10th Revision Australian Modification (ICD-10-AM), the Australian Classification of Health Interventions (ACHI) and the Australian Coding Standards (ACS).
These codes form part of a data collection that is used for research, funding and health care planning. The use of a classification system makes it easier to store, retrieve and analyse data.

14)- What are the three classifications of wound repair?
1.Simple
2.Intermediate
3.Complex

15)- What you think about medical billing future?
With the advent of healthcare reform, many people are looking into medical billing careers. The Occupational Outlook  Handbook says this career field is expected to grow through 2018, which means it is a solid and stable career choice. The great thing about most medical careers is that they remain steady even during an economic down turn. Medical billers take the coded medical record, and bill the insurance company. Medical billers work in doctors’ offices, clinics, and hospitals. It is possible for a medical biller to work at home as well. If you enjoy working in front of a computer, data entry, and keeping up with the latest health insurance rules and regulations, then this would be a great career choice for you.

16)- Define write-off in medical billing?
Write off is the difference between total charge and the allowable amount by the insurace. Write off is the difference between total charge and the allowable amount by the insurace.

17)- What is the full form of EOR?
Explanation Of Review.

18)- Name some good electronic billing software systems? 
Some of the best electronic billing systems include Sage and QuickBooks. These have been the industry leaders for a number of years. Both offer free trial versions to potential customers. 

19). What Is The Role Of Medical Coders And Billing People In Medical Industry? 

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 

 

20). Medical Billing And Coding – Question And Answers – Interview Purpose Name The Codes Used To Describe The Diagnosis? 

 ICD -9 or International classification of disease 

 

21)  Name The Codes Which Are Involved In Procedures? 

Current procedural terminology or CPT 

 

22)What Is The Core Purpose Of Super Bill? 

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. 

 

23) What Is The Percentage Normally Allowed In The Medicare Payment? 

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

 

24) Which Medicare Will Generally Pay For Medical Providers In The Healthcare Services – Either Part A Or Part B? 

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

 

25)Abbreviate Tos?  

Type of service 

 

26)What Could Exactly Pos Stand For?  

Place of service 

27)The Exact Abbreviation Of Ra In Medical Industry? 

Remittance Advice 

 

28) What Form Should Be Submitted For Professional Claim? 

HCFA – 1500 or CMS – 1500 

 

29). What Is The Process Involved Under Medical Billing? 

• 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 

 

30) What Are The Common Problems You Face In Medical Billing? 

• 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 

 

31) What Are The Duties Of Medical Billing Specialist? 

• 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 

 

32)What Are All The Certifications Involved In The Medical Billing And Coding Field? 

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) 

 

33) What Are The Types Of Medical Coding You Well Versed? 

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. 

 

34). What Is The Main Use Of Cpt Codes? 

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. 

 

35)What Is The Motivation You Receive In Medical?  

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. 

 

36)What Certifications Do You Hold? 

I am CPC, CHRS and CBCS certified. 

 

37)Have You Performed Billing Activities For Medicaid Or Medicare? How Was Your Experience? 

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. 

 

38) How Do You Manage Rejected Or Unpaid Claims? 

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. 

 

39)Have You Billed Or Coded For Any Specialties? 

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

 

40)Which Forms Have You Most Often Used In Your Current And Former Positions? 

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

 

41)Does Your Current Employer Use Emr Or Ehr? 

Yes. They use both. 

 

42) Which Type Of Software Have You Used: Epic, Medisoft Or Other Programs? 

I have had extensive experience using Epic. 

 

43) Which Medicare Will Generally Pay For Medical Providers In The Healthcare Services – Either Part A Or Part B? 

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

 

44)Are You Familiar With Hipaa Privacy Rules? Security Rules? 

 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. 

 

45) Have You Dealt Much With Resolving Issues With Unpaid Or Denied Claims? 

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. 

 

46)What Is Your Experience With Patient Collections? 

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. 

 

47)How Have You Dealt With Difficult Or Angry Patients? 

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. 

 

48)Do You Know How To Run Reports? Do You Know How To Customize Reports? 

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. 

 

49) What Type Of Certifications Do You Have? 

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. 

 

50)Are You Familiar With Electronic Medical Records (emr) Systems? Which Ones Have you Used? How Did You Use It? 

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. 

 

51)Have You Billed For Medicare And Medicaid? 

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.