Ace Analytics Interview Questions and Answers

RCM cycle stands for Revenue Cycle Management cycle, which is the process of managing claims, payments, and revenue generation in the healthcare industry.

• RCM cycle involves patient registration, insurance verification, charge capture, claim submission, payment posting, denial management, and reporting.

• It ensures that healthcare providers are properly reimbursed for their services.

• For example, a medical billing company may handle the RCM cycle for a hospital to ensure timely a...read more

ABN form stands for Advance Beneficiary Notice form, used in healthcare to inform Medicare beneficiaries of potential denial of payment for services.

• ABN form is used in healthcare to notify Medicare beneficiaries that Medicare may not cover a specific service or item.

• It is used when a provider believes Medicare will not pay for a particular service, and the patient may be responsible for payment.

• The ABN form must be signed by the patient before the service is provided.

• It help...read more

Copay is a fixed amount paid by the patient for a covered healthcare service, while deductible is the amount the patient must pay before insurance starts covering costs.

• Copay is a set fee paid by the patient at the time of service (e.g. $20 for a doctor's visit)

• Deductible is the amount the patient must pay out of pocket before insurance kicks in (e.g. $1000 deductible before insurance covers costs)

• Both copay and deductible are common terms in health insurance and impact the p...read more

UB04 claims are used for inpatient and outpatient hospital services billed to insurance companies.

• UB04 claims are used for inpatient and outpatient hospital services

• They include information such as patient demographics, dates of service, procedures performed, and diagnosis codes

• UB04 claims are typically used by hospitals, skilled nursing facilities, and other institutional providers

CO-50 denial is a common denial code in medical billing indicating that the services provided were not deemed medically necessary.

• CO-50 denial is used when the services provided are not considered medically necessary by the insurance company.

• It is important to review the documentation and ensure that the services meet the medical necessity criteria.

• Providers may need to submit additional documentation or appeal the denial to overturn a CO-50 denial.

• Examples of services that m...read more