50+ Senior AR Caller Interview Questions and Answers

I will ensure to manage my time efficiently during breaks and meals to avoid exceeding the allocated time.

• I will prioritize my tasks and plan my breaks accordingly to ensure I stay within the allocated time.

• If I do happen to exceed the break time, I will make sure to inform my supervisor and adjust my schedule to make up for the lost time.

• I will also try to identify any reasons for the delay and work on improving my time management skills to prevent it from happening again.

CMS1500 form fields and their uses, including BOX# 12,13,27 & 23.

• CMS1500 is a standard form used for submitting medical claims.

• BOX# 12 is used for indicating the patient's signature authorization.

• BOX# 13 is used for indicating the patient's signature date.

• BOX# 27 is used for indicating the provider's billing location.

• BOX# 23 is used for indicating the prior authorization number, if applicable.

I will prioritize breaks during slower periods and communicate with team members to ensure coverage.

• Prioritize breaks during slower periods to minimize impact on workflow

• Communicate with team members to coordinate break times and ensure coverage

• Plan ahead and schedule breaks accordingly to avoid disruptions

• Utilize tools like shift scheduling software to manage breaks efficiently

Handling authorization cases in AR calling

• Verify the patient's insurance coverage and benefits

• Obtain necessary authorizations from insurance companies

• Document all communication and authorization details

• Follow up with insurance companies to ensure timely approvals

• Educate patients on their financial responsibilities and options

• Escalate unresolved authorization issues to supervisors or managers

COBRA is a federal law that allows employees to continue their health insurance coverage after leaving their job.

• COBRA stands for Consolidated Omnibus Budget Reconciliation Act.

• It applies to companies with 20 or more employees.

• Employees can continue their health insurance coverage for up to 18 months after leaving their job.

• The employee is responsible for paying the full premium, including the portion previously paid by the employer.

• COBRA also applies to dependents of the emp...read more

CMS 100 is a medical claim form used for billing purposes.

• CMS 100 has 33 columns

• It includes patient information, provider information, and billing codes

• Some of the columns include patient name, date of birth, diagnosis codes, and procedure codes

I have worked in XYZ and ABC companies. Worked on softwares like A, B, and C.

• Worked in XYZ and ABC companies

• Experienced in using softwares like A, B, and C

• Proficient in using various billing and coding software

• Familiar with medical terminology and HIPAA regulations

Denial scenarios familiar to Senior AR Caller

• Missing or invalid information on claim form

• Service not covered by patient's insurance plan

• Lack of medical necessity for the service

• Duplicate claim submitted

• Timely filing limit exceeded

• Coordination of benefits issue

• Pre-existing condition exclusion

• Out-of-network provider

• Claim submitted to wrong insurance carrier

To obtain quickly in the sector manner, one should focus on improving productivity and efficiency.

• Identify and eliminate bottlenecks in the process

• Implement automation and technology to streamline tasks

• Train and develop employees to improve skills and knowledge

• Establish clear communication channels and set realistic goals

• Regularly review and analyze performance metrics to identify areas for improvement

Seashore cities are cities located on the coast of a sea or ocean.

• Seashore cities are popular tourist destinations due to their beaches and ocean views.

• Some famous seashore cities include Miami, Rio de Janeiro, Sydney, and Barcelona.

• Seashore cities often have a strong maritime culture and economy.

• These cities may also be vulnerable to natural disasters such as hurricanes and tsunamis.

• Living in a seashore city can provide opportunities for water sports and activities such as s...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

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

Modifiers are used to provide additional information about a procedure or service performed, while CPT codes are numeric codes used to describe medical, surgical, and diagnostic services.

• Modifiers are two-digit codes added to CPT codes to indicate that a service or procedure has been altered in some way

• Modifiers can affect reimbursement, denials, and audits

• Examples of modifiers include -25 (significant, separately identifiable evaluation and management service by the same phy...read more

Authorization is obtaining permission from an insurance company to provide a specific service, while referral is a recommendation from a primary care physician to see a specialist.

• Authorization is required for certain medical services or procedures to ensure coverage by insurance.

• Referral is a process where a primary care physician recommends a patient to see a specialist for further evaluation or treatment.

• Authorization is obtained by the healthcare provider from the insuran...read more

Feminism is a social and political movement advocating for equal rights and opportunities for women.

• Feminism aims to challenge and dismantle gender-based discrimination and inequality.

• It seeks to empower women and promote gender equality in various aspects of society, including politics, economics, and culture.

• Feminism encompasses a wide range of perspectives and approaches, including liberal feminism, radical feminism, and intersectional feminism.

• Examples of feminist issues ...read more

A claim form is a document submitted by a healthcare provider to request payment for services rendered to a patient.

• A claim form includes information such as patient demographics, insurance information, diagnosis codes, procedure codes, and billed amounts.

• It is used by healthcare providers to bill insurance companies or government programs for reimbursement.

• Submitting accurate and complete claim forms is crucial for timely payment and avoiding claim denials.

• Examples of claim ...read more

The two types of modifiers are descriptive and non-descriptive.

• Descriptive modifiers provide additional information about a service or procedure, such as location, time, or method (e.g. bilateral, multiple)

• Non-descriptive modifiers indicate that a service or procedure has been altered in some way, such as for a specific reason or to indicate a special circumstance (e.g. -22, -LT)

Referral is a recommendation for a service or treatment, while authorization is permission from an insurance company to receive that service or treatment.

• Referral is a recommendation from a primary care physician to see a specialist or receive a specific service.

• Authorization is permission from an insurance company to receive that service or treatment.

• Referral is typically required before authorization can be obtained.

• For example, a patient may need a referral from their prim...read more

AI plays a crucial role in automating tasks, improving efficiency, and making data-driven decisions in various industries.

• AI helps in automating repetitive tasks, saving time and resources.

• AI enables businesses to analyze large amounts of data quickly and accurately.

• AI can assist in making predictions and recommendations based on patterns in data.

• AI is used in various applications such as virtual assistants, chatbots, and autonomous vehicles.

• AI is constantly evolving and has ...read more

Denials with codes like CO 96, 97, 50

• CO 96 - Non-covered charge(s)

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

• CO 50 - These are non-covered services because this is not deemed a 'medical necessity' by the payer

ABN stands for Advance Beneficiary Notice in medical billing. It is a notice given to Medicare patients when a service may not be covered.

• ABN is used to inform Medicare patients that a service may not be covered by Medicare.

• It allows patients to decide whether to proceed with the service and accept financial responsibility if Medicare denies payment.

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

• Common scenarios where ABN is used include services that are co...read more

AOB stands for Assignment of Benefits in medical billing.

• AOB is a legal document signed by a patient that allows their health insurance benefits to be paid directly to the healthcare provider.

• It helps healthcare providers receive payment for services rendered without the patient having to pay upfront.

• AOB is commonly used in medical billing to streamline the payment process and reduce financial burden on patients.

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

Inclusive and denial are terms used in accounts receivable to describe payment statuses.

• Inclusive refers to payments that have been received and applied to the account.

• Denial refers to payments that have been rejected or not received.

• Inclusive payments are typically marked as 'Paid' or 'Received' in the system.

• Denial payments may require further investigation or follow-up with the payer.

• Understanding the status of payments is crucial for managing accounts receivable effective...read more

HIPAA stands for Health Insurance Portability and Accountability Act.

• HIPAA is a federal law that protects the privacy of individuals' medical records and health information.

• It sets standards for the security and confidentiality of healthcare information.

• HIPAA also includes provisions for ensuring the portability of health insurance coverage.

• Violations of HIPAA can result in significant fines and penalties.

• Examples of protected health information under HIPAA include patient na...read more

HIPAA is a US law that protects patients' medical information and ensures its confidentiality.

• HIPAA stands for Health Insurance Portability and Accountability Act.

• It sets standards for the protection of sensitive patient data.

• HIPAA regulations apply to healthcare providers, health plans, and healthcare clearinghouses.

• Examples of protected health information include patient names, addresses, medical records, and insurance information.

Authorization is the process of obtaining permission or approval to perform a specific action or access certain information.

• Authorization is necessary for accessing sensitive data or performing certain tasks.

• It involves verifying the identity and permissions of an individual or entity.

• Examples include obtaining authorization to access medical records or make financial transactions.

The impact of technology on modern society

• Technology has revolutionized communication, making it easier and faster

• It has transformed industries such as healthcare, education, and transportation

• Social media platforms have changed the way people interact and share information

Recoupment is the process of recovering overpaid funds or correcting payment errors.

• Recoupment involves recovering funds that were mistakenly paid out in excess.

• It can also refer to deducting money owed from future payments.

• Common in healthcare billing when insurance companies recoup overpayments by deducting from future claims.

• Recoupment can also occur in other industries such as finance or government.

• It is important to closely monitor recoupment activities to ensure accurac...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

I have extensive experience in healthcare management, including managing medical billing and coding processes.

• Managed medical billing and coding processes for a large healthcare organization

• Developed and implemented policies and procedures to ensure compliance with healthcare regulations

• Collaborated with healthcare providers to improve patient care and outcomes

• Analyzed healthcare data to identify trends and opportunities for improvement

C015 denial is a common denial code in medical billing indicating that the service is not covered by the patient's insurance plan.

• C015 denial typically means that the service provided is not covered by the patient's insurance plan.

• It is important to review the insurance policy to understand why the service was denied.

• Common reasons for C015 denial include lack of medical necessity, non-covered services, or incorrect coding.

• Appeals can be filed to challenge the denial and prov...read more

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

The process involves managing accounts receivable by following up on unpaid claims, resolving denials, and ensuring timely payment from insurance companies.

• Following up on unpaid claims

• Resolving denials

• Ensuring timely payment from insurance companies

Auth, duplicate denials refer to insurance claims being denied due to lack of authorization or being identified as duplicates.

• Auth denials occur when a claim is submitted without proper authorization from the insurance company.

• Duplicate denials happen when a claim is submitted more than once for the same service.

• These denials can result in delayed payments and require follow-up with insurance companies for resolution.

New and Old CPT codes are used in medical billing to describe medical procedures and services.

• New CPT codes are added every year to reflect new medical procedures and technologies.

• Old CPT codes may become obsolete or replaced by new codes.

• It is important for AR callers to stay updated on new and old CPT codes to ensure accurate billing and reimbursement.

• Example: CPT code 99213 (office visit) was replaced by 99214 in 2021.

• Example: CPT code 90834 (psychotherapy) was replaced by...read more

Denial codes from physician billing refer to the specific codes used to indicate reasons for claim denials.

• Denial codes help identify the specific reason for a claim denial, such as lack of medical necessity or incorrect coding.

• Common denial codes include CO-97 (payment adjusted because this procedure/service is not paid separately), CO-96 (non-covered charge(s)), and CO-16 (claim/service lacks information or has submission/billing error(s)).

• Understanding denial codes is cruc...read more

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, including Part A (hospital insurance), Part B (medical insurance), Part C (Medicare Advantage), and Part D (prescription drug coverage).

• It helps cover various healthcare services such as hospital stays, doctor visits, preventive care, and prescription drugs.

• Medicare is funded ...read more

Denials in medical billing are common reasons for claim rejection by insurance companies.

• Incorrect patient information

• Lack of pre-authorization

• Non-covered services

• Duplicate billing

• Timely filing exceeded

I'm sorry, but the question doesn't make sense. Can you please rephrase it?

• Request clarification on the question

• Ask for more context or information

• Apologize for not being able to answer the question

RCM cycle refers to the revenue cycle management process in healthcare, involving patient registration, insurance verification, coding, billing, and payment collection.

• Patient registration: Gathering patient information and insurance details.

• Insurance verification: Confirming coverage and eligibility.

• Coding: Assigning appropriate medical codes to diagnoses and procedures.

• Billing: Generating and submitting claims to insurance companies.

• Payment collection: Receiving payments fr...read more

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, coding, billing, and collections.

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

• Example: A patient visits a doctor, the doctor's office verifies the patient's insurance, submits a claim to the insurance company, and follows up o...read more

Aob in RCM stands for Assignment of Benefits, which is a legal authorization given by a patient to allow their insurance company to pay the healthcare provider directly.

• Aob is a common term used in Revenue Cycle Management (RCM) in the healthcare industry.

• It is a form signed by a patient that authorizes their insurance company to pay the healthcare provider directly for services rendered.

• Aob helps streamline the billing process and ensures that the healthcare provider receive...read more

ABN stands for Advanced Beneficiary Notice. It is a notice given to Medicare patients when a service is likely not going to be covered.

• ABN is used to inform Medicare patients that a service may not be covered by Medicare.

• It allows patients to make an informed decision about whether to proceed with the service and potentially be responsible for payment.

• ABN is typically used for services that are considered medically unnecessary or not covered by Medicare.

• Examples of services t...read more

Explanation of AR caller role in healthcare industry

• AR callers are responsible for following up on unpaid medical claims

• They work with insurance companies to resolve billing issues

• AR callers need to have strong communication and problem-solving skills

• Examples: contacting insurance companies to verify coverage, appealing denied claims

AOB stands for Assignment of Benefits, which is a legal agreement between a patient and their healthcare provider allowing the provider to receive payment directly from the patient's insurance company.

• AOB is commonly used in medical billing to ensure that healthcare providers receive payment for services rendered.

• It is important for AR callers to understand AOB agreements in order to effectively communicate with insurance companies and patients.

• Examples of situations where AO...read more