Top 10 Medical billing Interview questions

What is an Authorization in medical billing?

Provider must obtain an authorization number(permission) from an insurance company, before patient can receive certain treatment or services. An authorization number can be found on box# 23 on the HCFA claim form.

What is an AR aging report in medical billing?

An AR aging refers to the outstanding amount or unpaid insurance/patient balances that are due past 30 days. Most billing software’s have the ability to generate a separate AR aging report for insurance balances and patient balances, we call this as insurance aging and patient aging respectively. An AR aging reports list balances by 30, 60, 90, 120 & 180 days.

What is ABN in medical billing?

An ABN is also called as an Advance Beneficiary Notice. It’s a notice issued by medical provider to Medicare beneficiaries, when they found the services are not covered by Medicare, then in that case patient will be responsible for the cost of the treatment provided.

What is Capitation and Fee for service?

Capitation is the fixed amount paid to the healthcare provider from an insurance company over defined period of time for the patient treatments, and this payment is not affected by the number/type of services rendered.

Fee for service known as FFS is a method in which doctors are paid for each service or procedure performed.

What is Assignment of Benefits?

Assignment of Benefits also called as an AOB. It is a document signed by patient, authorizing insurances to pay the payments directly to healthcare provider for a patient’s treatment. It is designated on box# 27 on the HCFA claim form.

What is Managed care plan and Types of Managed care Plan?

Managed care plan is a health insurance plans to ensure high quality care at reduced costs and also to ensure the procedure performed is medically necessary and appropriate.

Types of Managed care plans are as follows: HMO-Health Maintenance Organization, PPO-Preferred Provider Organization, POS-Point of Service & EPO-Exclusive Provider Organization.

What is Place of service?

It’s a 2-digit code used on claim form to indicate the place the services performed. It is indicated on block# 24B on HCFA claim form.

Examples: POS 11 – Office visit, POS 20 – Urgent care facility, POS 21 – Inpatient Hospital, POS 23 – Emergency room hospital, POS 24 – Ambulatory surgical center         

What is Copay, Coinsurance and Deductible?

Copay – It’s an amount paid by the patient to the health care provider at the time of each visit, as defined by the insurance company.

Coinsurance – It’s a percentage or amount defined in the insurance plan for which the patient is responsible. Most plan have a ratio of 90% insurance pays/10%patient pays, 80%insurance pays/20%patient pays, 70%insurance pays/30%patient pays etc.

Deductible – It’s an amount patient must pay to provider, before insurance company starts paying the healthcare benefit. For example: Consider annual insurance deductible for patient is $1000. In this case patient has to pay first to the provider for the covered services till it meet $1000 deductible. Once $1000 met, then insurance starts paying the benefit.

What is a Superbill in medical billing?

It is one of the most frequently used medical billing terms by medical billing and coding team, which outlines the healthcare services provided by a doctor to its patient. It includes ICD codes, CPT codes, modifier, place of service, date the services rendered, patient and provider information.

What is a Modifier?

Modifier is a two-character code that is used to provide additional information to insurance company for procedure that have been altered, but not changed in its definition. Important modifiers we come across regularly in medical billing are as follows: 50 – Bilateral, LT – Left, RT – Right, 51 – Multiple, 26 – Professional component, TC – Technical component, 25 – E/M Service etc.

What is an Appeal in medical billing?

When an insurance company does not reimburse the treatment or a claim billed, a request is made to an insurance company with supporting documentation to review the decision is called as an appeal.

What is an Ambulatory Surgery?

Outpatient surgery or surgical procedures that does not need an overnight hospital stay. It means patient doesn’t require to being admitted and can leave the hospital on the same day surgery performed. Example: Hernia repair, Eye cataract surgery etc.

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