10+ 2COMS Interview Questions and Answers

Referral is a recommendation for a specialist or service, while Auth is approval for a specific medical service or treatment.

• Referral is a request for a patient to see a specialist or receive a specific service.

• Auth is the approval given by the insurance company for a specific medical service or treatment.

• Referral is usually initiated by the primary care physician, while Auth is initiated by the specialist or service provider.

• Referral is not a guarantee of coverage, while Aut...read more

Anthem and Blue Shield are both health insurance companies, but they operate in different regions and have different networks of healthcare providers.

• Anthem operates in 14 states, while Blue Shield operates in California

• Anthem is a member of the Blue Cross Blue Shield Association, while Blue Shield is an independent licensee

• Anthem offers plans on the healthcare exchange in all of the states where it operates, while Blue Shield only offers plans in California

• Anthem has a large...read more

I achieve my daily targets consistently.

• I set achievable daily targets based on my workload and priorities.

• I track my progress throughout the day and adjust my approach if necessary.

• I communicate with my team to ensure we are all aligned on our goals.

• Examples: completing a certain number of tasks, meeting a specific deadline, reaching a sales quota.

CPT and ICD are medical coding systems used to classify medical procedures and diagnoses for billing and statistical purposes.

• CPT stands for Current Procedural Terminology and is used to code medical procedures and services.

• ICD stands for International Classification of Diseases and is used to code medical diagnoses and conditions.

• Both coding systems are used for billing and statistical purposes in the healthcare industry.

• CPT codes are updated annually by the American Medical...read more

My quality scores are consistently high, reflecting my attention to detail and commitment to excellence.

• My quality scores are consistently high across all projects and tasks

• I prioritize attention to detail and accuracy in all my work

• I am committed to delivering high-quality results that meet or exceed expectations

I work on denials by identifying the reason for denial, appealing the claim, and implementing corrective measures.

• Review the denial reason code and identify the root cause

• Appeal the claim with supporting documentation

• Implement corrective measures to prevent future denials

• Track and monitor the denial trends to identify patterns

• Collaborate with the billing team and healthcare providers to resolve denials

• Provide education and training to staff on denials management

MCR stands for Medicare Cost Report, while MCR managed care refers to managed care organizations that participate in the Medicare program.

• MCR is a financial report submitted by healthcare providers to Medicare to report costs and utilization of services.

• MCR managed care refers to managed care organizations that contract with Medicare to provide healthcare services to beneficiaries.

• MCR focuses on financial data, while MCR managed care involves the delivery and management of he...read more

Medicare does not have deductibles for most services, but there are some exceptions.

• Medicare Part A has a deductible for hospital stays, which is $1,484 per benefit period in 2021.

• Medicare Part B has an annual deductible, which is $203 in 2021.

• Medicare Advantage plans may have their own deductibles, which vary by plan.

• Medicare does not have deductibles for most preventive services.

End payment posting process involves reconciling payments received with billed charges. ERA/EOB are electronic remittance advice/explanation of benefits.

• End payment posting process involves matching payments received with billed charges

• Verify accuracy of payments and adjustments

• Update patient accounts with payment information

• ERA (Electronic Remittance Advice) is an electronic document that provides details about payments and adjustments made by insurance companies

• EOB (Explana...read more

Authorization is required to ensure that services provided are covered by the patient's insurance and to prevent fraud.

• Authorization ensures that services provided are covered by the patient's insurance plan.

• It helps prevent fraud by verifying that the services rendered are necessary and appropriate.

• Authorization may be needed for certain procedures, tests, or treatments before they can be performed.

• Insurance companies require authorization to control costs and ensure proper ...read more