CHANDERPUR WORKS Interview Questions and Answers

Contracted providers have a formal agreement with the payer, while non-contracted providers do not.

• Contracted providers have negotiated rates and terms with the payer.

• Non-contracted providers do not have a formal agreement with the payer.

• Contracted providers may have lower reimbursement rates but more consistent payment.

• Non-contracted providers may have higher reimbursement rates but less consistent payment.

• Contracted providers may have specific billing requirements and guide...read more

Co-payment, co-insurance and deductible are all cost-sharing methods in healthcare, but differ in their application and purpose.

• Co-payment is a fixed amount paid by the patient for each visit or service, usually at the time of service.

• Co-insurance is a percentage of the total cost of care that the patient is responsible for paying, after the deductible has been met.

• Deductible is the amount the patient must pay out of pocket before insurance coverage begins.

• For example, a pati...read more

RCM process in US healthcare involves managing the financial aspects of patient care, from registration to payment collection.

• RCM stands for Revenue Cycle Management.

• It includes various steps such as patient registration, insurance verification, coding and billing, claim submission, payment posting, and denial management.

• The goal is to optimize revenue generation and ensure timely reimbursement.

• For example, a Payment Posting Specialist is responsible for accurately posting pa...read more

COB stands for Coordination of Benefits, while EOB stands for Explanation of Benefits.

• COB is a process used by insurance companies to determine the order in which multiple insurance policies will pay for a claim.

• EOB is a document sent by an insurance company to a patient explaining how a claim was processed and what portion of the costs are covered.

• COB helps prevent overpayment and ensures that claims are paid correctly.

• EOB provides details about the services rendered, the am...read more

CPT, HCPCS codes and Modifiers are used in medical billing to describe procedures, services, and supplies provided to patients.

• CPT codes are used to describe medical procedures and services provided by healthcare professionals.

• HCPCS codes are used to describe medical supplies, equipment, and services provided to patients.

• Modifiers are used to provide additional information about a procedure or service, such as the location or extent of the service.

• Modifiers are added to CPT o...read more

Medicare and Medicaid are government-funded healthcare programs in the US, but with different eligibility criteria and coverage.

• Medicare is for people aged 65 and older, or those with certain disabilities or end-stage renal disease.

• Medicaid is for people with low income and limited resources.

• Medicare is federally funded, while Medicaid is jointly funded by the federal and state governments.

• Medicare covers hospital stays, doctor visits, and some medical equipment, while Medica...read more

Denial management is the process of identifying and resolving claim denials from insurance companies or other payers.

• It involves analyzing the reasons for denials and taking corrective actions.

• It includes appealing denied claims, resubmitting corrected claims, and negotiating with payers.

• Effective denial management can improve revenue cycle management and increase cash flow.

• Examples of common denial reasons include incorrect patient information, lack of medical necessity, and...read more