Medical Billing Interview Questions
Top 100 Medical Billing Interview Questions & Answers for 2024
Medical Billing Interview Questions for freshers
1. What is the role of medical billing, and how does it differ from medical coding?
Medical billing is the process of creating and sending bills to insurance companies to get payment for medical services. Medical coding masters is About assigning specific codes to diagnoses and treatments. Coding comes first, and billing uses those codes to create the bills.
2. What are the key duties and responsibilities of a medical biller?
A medical biller’s job includes checking patient info, preparing bills, sending them to insurance, following up on unpaid bills, and making sure everything follows the rules.
3. Which forms are most commonly used in medical billing?
The CMS-1500 form is used for doctor services, and the UB-04 form is used for hospital services. These are the main forms in medical billing.
4. Could you explain what ‘denial management’ means in the context of medical billing?
Denial management is about finding out why insurance claims get denied and fixing those issues to get payment faster.
5. How would you approach a claim that has been rejected?
I did check the claim for errors like wrong patient details or codes, fix them, and resubmit it.
6. What methods do you use to keep up with changes in medical billing regulations?
I keep updated by reading industry news, attending webinars, and taking courses on new billing rules.
7. Can you describe a complex billing process you managed and how you addressed it?
I handled a case where the patient had two insurance plans. I coordinated with both insurers to make sure the claim met all requirements and was paid correctly.
8. What strategies do you use to reduce the likelihood of claim denials?
I make sure that patient details and codes are accurate, and that we are following insurance policies.
9. How do you manage disputes with insurance providers?
I gather all the needed documents, keep clear records, and communicate with the insurance company to solve the problem.
10. What positive impact have you made in your previous medical billing roles?
I created a double-check system to catch errors before claims were sent, which helped get claims paid faster.
11. How do you lead and support a medical billing team?
I encourage teamwork, provide clear instructions, and offer training so everyone is up to date on rules and policies.
12. What medical billing specialties do you have experience with?
I’ve worked in areas like orthopedics, cardiology, and pediatrics, each of which has unique billing rules.
13. Have you encountered and resolved a claim error in a clearinghouse setting?
Yes, I once found a duplicate claim error, corrected it, and resubmitted it, which allowed the claim to be processed.
14. How do you keep yourself informed of updates in medical billing regulations?
I read industry news, attend seminars, and keep up with updates from official sources like CMS.
15. Could you explain the differences between HMO and PPO insurance plans?
HMO plans require patients to pick a primary doctor and have lower costs. PPO plans allow more flexibility in choosing doctors but are more expensive.
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Medical Billing Interview Questions & Answers
Medical Billing Interview Questions
16. What measures do you take to protect patient confidentiality?
I follow HIPAA guidelines, use secure systems, and make sure only authorized people have access to patient data.
17. How do you approach difficult conversations with patients or insurance companies?
I listen carefully, stay calm, and explain billing details clearly so both patients and insurance reps understand.
18. What are some of the common challenges in medical billing, and how do you handle them?
Common challenges include claim denials and rule changes. I stay updated on rules, double-check claims, and communicate with insurers to manage these challenges.
19. Why are you interested in working in medical billing?
I like that medical billing requires organization and attention to detail, and I enjoy helping healthcare facilities get paid for their services.
20. Approximately how many invoices do you process daily?
On a typical day, I handle about 30-50 invoices, depending on the number of claims and how complex they are.
21. What is a clean claim?
A clean claim has no errors, all information is accurate, and it meets all the insurance company’s requirements for immediate processing.
22. What do you do if you notice an error on a claim?
I immediately correct it, check for other possible errors, and resubmit it to avoid delays.
23. What are the steps involved in the billing cycle?
Patient registration, insurance verification, coding, claim preparation, submission, payment posting, and follow-up on denials.
24. What are accounts receivable (AR) in medical billing?
AR is the amount owed by patients or insurance to the healthcare provider after billing.
25. How do you track unpaid claims?
I use billing software to monitor unpaid claims and set reminders for follow-ups.
26. What is an EOB?
Explanation of Benefits (EOB) is a statement sent by insurance companies to explain payment or denial of claims.
27. How do you handle rejected claims?
I investigate the reason for rejection, correct errors, and resubmit the claim as soon as possible.
28. What is revenue cycle management?
It’s the entire process of managing claims, payments, and revenue generation for healthcare services.
29. What are CPT codes?
Current Procedural Terminology (CPT) codes are used to describe medical services and procedures.
30. What is ICD-10?
It’s the 10th revision of the International Classification of Diseases, used for diagnosis coding.
How do I prepare for a billing interview?
- Review billing basics, medical terms, and the billing process.
- Familiarize yourself with medical coding systems (e.g., ICD-10, CPT) and common forms like CMS-1500.
- Practice explaining steps like claim submission, error correction, and handling denied claims.
- Understand patient privacy rules, especially HIPAA compliance.
- Practice answering common interview questions to build confidence.
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Medical Billing Interview Questions & Answers
Medical Billing Interview Questions
31. How do you deal with multiple insurances for one patient?
I coordinate benefits, ensuring primary and secondary insurers cover their parts correctly.
32. What is patient responsibility?
This is the amount a patient needs to pay after insurance has covered its portion.
33. What does the term ‘appeal’ mean in medical billing?
An appeal is a request to review and reconsider a denied claim for payment.
34. What software are you familiar with in medical billing?
I am skilled in software like Kareo, Epic, and Cerner.
35. What is a deductible?
It’s the amount a patient must pay out-of-pocket before insurance starts covering expenses.
36. Explain prior authorization.
Prior authorization is approval from the insurer for certain treatments or medications before they’re covered.
37. What’s the difference between a copay and coinsurance?
A copay is a fixed amount a patient pays, while coinsurance is a percentage of the total cost they share with insurance.
38. What is an out-of-pocket maximum?
It is the most a patient pays in a year, after which insurance covers 100% of costs.
39. Describe your experience with HIPAA.
I am well-versed in HIPAA, ensuring patient privacy and secure handling of medical information.
40. What is bundling in medical billing?
Bundling is when multiple services are combined under a single code for billing.
41. How do you prioritize your work when managing multiple claims?
I prioritize claims based on urgency, insurer deadlines, and potential payment amounts.
42. What are HCPCS codes?
Healthcare Common Procedure Coding System (HCPCS) codes are used for items like medical equipment and supplies.
43. How do you ensure compliance in billing?
By staying updated with regulations, following procedures, and using compliant software.
44. What is claim scrubbing?
Claim scrubbing checks for errors before submitting claims to minimize rejections.
45. How do you handle patient inquiries about billing?
I explain their charges clearly and assist with questions about insurance or out-of-pocket costs.
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Medical Billing Interview Questions & Answers
Medical Billing Interview Questions
46. What is a superbill?
A superbill is a detailed invoice that outlines services rendered for insurance claims.
47. What does it mean if a claim is ‘pending’?
A pending claim is one that is awaiting processing or additional information from the provider or patient.
48. How do you stay organized with billing tasks?
I use software tools, set reminders, and categorize claims based on their stage.
49. What’s your experience with denial codes?
Denial codes indicate why a claim was denied; I review them to understand and fix errors.
50. Describe fee-for-service vs. capitation.
Fee-for-service pays per treatment, while capitation is a set fee paid periodically for all services provided.
51. How do you handle duplicate claims?
I check for duplicates before submission and immediately correct any duplicate claims in the system.
52. What are payer-specific rules?
Different insurance companies have unique rules for claim processing; knowing these rules helps avoid rejections.
53. Explain the term ‘secondary insurance’.
Secondary insurance is additional coverage that pays after the primary insurance.
54. What is an encounter form?
It’s a form used to record details of patient services for billing purposes.
55. What are modifiers in medical billing?
Modifiers are codes added to CPT codes to give more detail on a procedure.
56. What is medical necessity?
Services must be medically necessary, meaning they are required for patient care, to qualify for insurance coverage.
57. How do you handle a high volume of claims?
I stay organized, use batch processing, and rely on efficient software tools.
58. What is a clearinghouse in medical billing?
A clearinghouse is a third-party system that helps process and check claims before sending them to insurance.
59. What’s the difference between pre-authorization and referral?
Pre-authorization is insurer approval for a procedure, while a referral is permission to see a specialist.
60. How do you handle late payments?
I send reminders, follow up with insurance, and may involve collections if necessary.
What is the billing process?
- Starts with patient registration and insurance verification.
- Adds medical codes for services and diagnoses.
- Claims are submitted to insurance for payment approval.
- If approved, payment is processed; if denied, claims are corrected and resubmitted.
- Ends with billing the patient for any remaining balance and following up on unpaid amounts.
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Medical Billing Interview Questions & Answers
Medical Billing Interview Questions
61. What’s your experience with audits?
I have participated in internal audits to ensure compliance and accuracy in claims.
62. What’s a TPA (Third-Party Administrator)?
TPAs manage insurance policies for self-insured employers, handling claims and billing.
63. What’s a PPO (Preferred Provider Organization)?
A PPO is a network of healthcare providers that offers flexibility in choosing doctors but at a higher cost.
64. Explain ‘write-offs’ in billing.
Write-offs are portions of a bill that are waived or not expected to be collected.
65. What’s an HMO (Health Maintenance Organization)?
HMO plans require choosing a primary doctor and limit out-of-network coverage.
66. What’s your process for resolving a billing error?
I find the error, correct it, update the claim, and re-submit it to avoid delays.
67. How do you educate patients on billing?
I provide simple explanations about their bills and answer questions about insurance and payment.
68. How do you handle overpayments?
I track the overpayment, process a refund if needed, and update the patient’s account.
69. How do you handle incomplete claims?
I gather missing info and complete the claim before resubmission.
70. How do you avoid coding errors?
By double-checking codes, staying updated on coding standards, and using coding software.
71. Explain co-insurance.
Co-insurance is a shared cost between patient and insurer after deductibles are met.
72. What is aging in AR?
Aging tracks how long claims have been unpaid, helping focus on overdue claims.
73. What is CPT Category II?
These are tracking codes used for performance measurement.
74. Explain HIPAA.
HIPAA is a law that protects patient privacy and ensures secure handling of medical data.
75. What’s a deductible?
A deductible is what the patient pays before insurance coverage kicks in.
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Medical Billing Interview Questions & Answers
Medical Billing Interview Questions
76. What is an ERA?
Electronic Remittance Advice (ERA) is an electronic version of an EOB, detailing payment information.
77. Explain adjustment codes.
Adjustment codes specify why payment adjustments were made on claims.
78. What is an in-network provider?
Providers in the insurer’s network who offer services at a negotiated rate.
79. Explain patient demographics.
Demographics include patient info like age, gender, and insurance, which is needed for billing.
80. What’s a TIN?
TIN is the Tax Identification Number, used for tax and billing identification.
81. Explain the global period in billing.
Global period is a timeframe in which follow-up services are included in a procedure’s fee.
82. What’s an out-of-network provider?
Providers outside the insurance network, generally with higher patient costs.
83. Explain RBRVS.
Resource-Based Relative Value Scale is a system used to determine payments for services.
84. How do you manage high claim volumes?
I prioritize claims, use batching, and rely on software tools for efficient processing.
85. How do you ensure compliance with medical billing laws?
Staying informed on laws, training, and checking for errors helps ensure compliance.
86. What is provider credentialing?
It’s the process of verifying a provider’s qualifications for billing insurance.
87. Explain medical coding’s role in billing.
Medical Coding confirms accurate billing by translating services into universally accepted codes.
88. How do you track payment postings?
I use software to record payments accurately and flag unpaid claims for follow-up.
89. What’s an NPI?
National Provider Identifier (NPI) is a unique ID for healthcare providers.
90. Explain PPO vs. HMO plans.
PPOs offer more provider choice with higher costs; HMOs require in-network providers.
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Medical Billing Interview Questions & Answers
Medical Billing Interview Questions
91. How do you handle patient refunds?
I verify the overpayment and follow the process to issue a refund.
92. Explain batch processing.
Batch processing groups claim for faster and more efficient submission.
93. What is an allowable charge?
It’s the maximum amount an insurer will pay for a covered service.
94. How do you verify insurance coverage?
I call the insurer or check online to confirm coverage and limitations.
95. What is an insurance claim scrubber?
It is a tool that checks claims for errors before submission to avoid denials.
96. What’s your approach to patient collections?
I communicate clearly, set up payment plans if needed, and follow up respectfully.
97. Explain denial management.
It is identifying denial reasons, correcting claims, and resubmitting them.
98. How do you handle high rejection rates?
I analyze rejection causes, adjust billing practices, and resubmit accurate claims.
99. What’s your experience with medical terminology?
I am familiar with essential medical terms used in billing and coding.
100. Why is attention to detail important in medical billing?
Accurate billing avoids claim rejections, ensures compliance, and improves payment timeliness.
What is the medical billing role?
- Ensures healthcare providers get paid for services provided.
- Submits and follows up on claims, resolving issues with insurance if needed.
- Applies accurate codes to services and maintains patient account records.
- Protects patient information and ensures HIPAA compliance.
- Requires attention to detail, billing knowledge, and good communication.
