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

Medicare is a federal health insurance program for people who are 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease.

• Medicare is divided into different parts: Part A covers hospital stays, Part B covers medical services, Part C includes private insurance plans, and Part D covers prescription drugs.

• Medicare is funded through payroll taxes, premiums, and general revenue.

• Medicare beneficiaries can choose to receive their benefits throu...read more

Workers comp is a form of insurance that provides wage replacement and medical benefits to employees who are injured on the job.

• Workers comp covers medical expenses for work-related injuries or illnesses

• It also provides wage replacement for employees unable to work due to a work-related injury

• Employers pay for workers comp insurance to protect their employees and themselves from legal action

• Workers comp laws vary by state, with different requirements and benefits