AR Analyst Interview Questions and Answers

HMO stands for Health Maintenance Organization in medical billing.

• HMO is a type of health insurance plan that typically requires patients to choose a primary care physician (PCP) and obtain referrals to see specialists.

• In HMOs, patients usually have lower out-of-pocket costs but are limited to a network of healthcare providers.

• HMOs focus on preventive care and wellness programs to keep patients healthy and reduce healthcare costs.

• Examples of HMOs include Kaiser Permanente and...read more

Explanation of 5 denials with denial codes

• Denial code CO-97: Payment was denied because the benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated.

• Denial code PR-96: Patient is responsible for the deductible amount.

• Denial code OA-23: The impact of prior payer(s) adjudication including payments and/or adjustments.

• Denial code M-80: Service not related to the patient's diagnosis.

• Denial code N-130: Consult ser...read more

RCM stands for Revenue Cycle Management, which is the process of managing the financial aspects of healthcare services.

• RCM involves managing the entire patient journey from registration to payment.

• It includes tasks such as verifying insurance eligibility, submitting claims, and following up on denials.

• RCM aims to optimize revenue and reduce costs for healthcare providers.

• Examples of RCM software include Epic and Cerner.

Modifiers are words that change or limit the meaning of another word.

• Adjectives are modifiers that describe nouns or pronouns

• Adverbs are modifiers that describe verbs, adjectives, or other adverbs

• Quantifiers are modifiers that indicate the amount or quantity of something

• Comparatives and superlatives are modifiers that indicate degrees of comparison

• Prepositional phrases are modifiers that provide additional information about a noun or verb

Denials in AR analysis refer to reasons for claim rejections and actions taken to resolve them.

• Common reasons for denials include incorrect patient information, such as misspelled names or wrong insurance details.

• Lack of prior authorization can lead to denials; ensuring all necessary approvals are obtained beforehand is crucial.

• Coding errors, like using outdated or incorrect codes, often result in claim denials; regular training on coding updates is essential.

• Timely filing li...read more

AR (Accounts Receivable) refers to the amount of money owed to a company by its customers. Denials are when insurance companies refuse to pay for a medical service.

• AR is an important metric for businesses to track their financial health

• Denials can occur for various reasons such as incorrect coding or lack of medical necessity

• AR analysts work to identify and resolve denials to ensure timely payment

• Effective denial management can improve cash flow and reduce revenue loss

• Example...read more

Mb in us refers to megabytes in the United States, a unit of digital information storage.

• Mb stands for megabytes, a unit of digital information storage.

• In the United States, Mb is commonly used to measure file sizes, data storage capacities, and internet speeds.

• 1 Mb is equal to 1,000,000 bytes or 1,024 kilobytes.

• For example, a typical MP3 music file may be around 3-4 Mb in size.