Most of these questions should be solvable in ~10-15 minutes, some will be more like 20-25. Health Information Management (HIM) Services, KnowledgeSource & KnowledgeSource Professional, Meet our Technology and Services leadership team, Redefining Revenue Cycle Management in Hospitals, Seven Steps to Optimized Medical Coding Health Solutions – A Checklist Guide, ‘Buy’ Improvement with nThrive Revenue Cycle Analytics, Denial Management: 8 Tips on How to Prevent Denied Claims. The outpatient throughput committee puts controls in place that state if a physician has a patient procedure scheduled for the next day, cutoff time for adding anything else is noon of this day. http://www.ama-assn.org/ama/pub/physician-resources/practice-management-center/health-insurer-payer-relations/national-health-insurer-report-card/denials.page. If all your edits are easy and allow your claims to push through because you haven’t built in edits that could prevent or mitigate certain denial reasons, your claim rate is going to look high, but so are your denials, because you’re not taking the action necessary to prevent that denial from occurring. At a high level, the two most common causes are 1. This repository will help you know what kind of questions to expect and you can also practice the questions in this repository. What Is Medical Coding? There is a narrow window of time in which to look at this newly scheduled service that has come in, determine whether it requires another authorization or modification of the existing, and what must be done to get the authorization, if it is required. Methodology for working and routing technical denials is based on the provider’s preference, but clinical denials require special handling, routing and segmentation. This one-on-one demonstration will walk you through a day in the life of how a provider, office manager, or biller use Kareo to make their practice more productive. If the same problem recurs, evaluate the process root cause instigating the issue and eliminate it by implementing a corrective action using technology. Your guide to exceeding a 95% clean claims rate and speeding up insurance payments. We’ve selected several good questions to share … A deductible. You must have data that identifies the type of medical billing denial occurring and the source of the denial. Interviewer kept saying excellent/very good. Then you find out that what you sent to the payor began with an alphabetic character preceding the numeric value of the authorization, which indicates it is a reference number that has not yet been converted to an approved authorization. An approved authorization is numerical with no alpha character in front. By doing that, you have built in an edit that can prevent a denial from occurring in the future. The basic requirements for this position are a high school degree and the ability to use computer accounting programs. We define these as tasks that push the denial toward final resolution. Advice from RCM Expert Elizabeth Woodcock, E-Prescribing Option Helps With Medication Compliance and Patient Outcomes, Getting Paid in 2020: Steps to Take Now for a Smooth Transition to the New Year, How Billing Companies Benefit from Consolidating to One Platform. We analyzed thousands of coding interviews. Still not finding what you’re looking for? BK: Good question - effective denial root cause resolution is the result of upstream prevention and mitigation. This is typically an entry level role. I am creating this repository because initially I faced a lots of rejection because there was no resource like this. We do not claim our questions will be asked in any interview you may have. Learn the ABCs of what it means to prepare for a medical coding and billing job interview and discover the secrets of selling yourself to your interviewers. Build a custom tailored solution that fits your practice’s needs. Medical Billing/Coding Specialist Interview Questions Great medical-billing and coding professionals are chameleons -- they’re able to alter themselves to adapt to daily challenges. Different ways to reduce the traffic or solve network design problems. What Is The Core Purpose Of Super Bill? Technical issues are usually a more straightforward fix, such as incorrectly ranked insurance resulting in a claim billed to the secondary as the primary in error. “They have to have a bit of fight in them and not be afraid to challenge a claim denial,” she says. Interview theory and coding questions of all companies : Company wise all practice questions. Doctor Jones is sending a fax over right now to the scheduling department saying, “I want to add on this additional procedure.” My team is staffed until 4:30 or 5 p.m. tonight and the insurance company closes between 6 and 8 p.m. tonight. Not only do you get practice interview questions and answers, but we create detailed explanation videos for each solution, showing you how to solve it in an interview. reversing an array, sorting the array, or searching elements on the array. If another team refuses to cooperate, escalate the issue up to the CFO. GS: I recommend a standard daily productivity metric for both technical and clinical denials of 25 resolution actions per day. Our goal is to create interview questions and answers that will best prepare you for your interview, and that means we do not want you to memorize our answers. A larger health system or single facility can gain efficiencies with a clinical team, a technical team, and a follow-up team, and duties can be distributed across all three groups. Getting Paid in 2020: What Independent Medical Practices Need to Know. That takes the case manager and care transition specialist away from managing the active patient cases, thereby increasing the risk for yet another denial. Questions were either straight from or similar to questions in Cracking the Coding Interview. By using our website you consent to our cookies in accordance with our Cookie Policy. BK: Yes and no. How to Describe Your Work Pace During a Job Interview. This question is a great example of a common question that covers two categories, Personality Traits and Communication Skills. While your candidate does not necessarily need to have certifications in medical billing or coding, those who already have certifications may have a leg up over other applicants. A good book to prepare for programming job interviews in a short time. When writing clinical appeals, engage a clinician to work the account, evaluate, pull the records and loop in coding if more information is needed. Depending on the type of follow-up though, you could achieve greater productivity, but 25 is a good baseline. Experience Job Interview Questions and Tips on How to Best Respond. Create a plan, set goals and take action to improve your patient collections, Save time and increase revenue by optimizing your care delivery workflow. Review the DRG validation and the clinical validation. Managing denials is more difficult in 2018 than it was in 2005, 2000, or 1998. 4 denial management specialist interview questions. In a recent nThrive medical billing webinar hosted by HFMA, “The Path to Success in Proactive Denials Management & Prevention,” reimbursement strategies were shared for preventing medical claim denials throughout the health care revenue cycle. We’ve selected several good questions to share with everyone. Billing specialists, also known as billing clerks, are found in industries of every kind. Particularly for clinical denials, it is important to identify and document the root cause so that steps can be taken upstream to improve those practices. By Gina Stinson, Vice President of Managed Care Services and Bill Knox, Vice President of Product Management | Posted: 05/21/2018. Next, ensure claims are processed properly, particularly those high dollar claims. If you would like to be placed in a medical coder or remote medical coder job within the United States, please fill out the form below or call us at 602-468-6300. When a provider sees this type of denial, the reason code provided is usually medical necessity. The payor does not indicate, “this is a DRG downgrade.” That’s something the provider must identify. How to Answer Job Interview Questions About Pet Peeves. This is what we refer to as edit management. Time yourself. Using the gross value of the denial can put a provider at risk for overinflating the value, which could impact the provider’s long-term financials. Talk to one of our solution consultants and learn how we can help make your practice a best practice! by Aline Lerner. Medical Coding Interview Questions / Job Guide — VIDEO. Here's a quick overview of changes in CMS programs, insurance plans and patient payments. Medical coding professionals provide a key step in the medical billing … Working on a clinical denial, which includes medical necessity, requires more knowledge and expertise on the denial evaluation process. Or the control could state that if a requested procedure requires authorization, the authorization must be confirmed prior to scheduling. If you’re reading this post, there’s a decent chance that you’re about to re-enter the crazy and scary world of technical interviewing. Don’t waste effort on smaller claims – reconsider trying to resolve a $20 claim that didn’t process and had a defined deadline. DRG downgrades are typically worked as denials. GS: First, I’ll define DRG, which stands for diagnosis-related groups and is the basis for establishing medical reimbursements. Below are questions commonly asked during a medical coding interview. What are Your Rejections and Denials Trying to Tell You? A technical issue, such as an incorrectly calculated DRG or perhaps a technical mistake, and 2. Example: The hospital bills out DRG 300 to the payor, but it’s paid as DRG 298, a lower rate. “They have to be patient, flexible, and able to diffuse patient emotions.” Interview Questions Proper interview questions thoroughly assess the candidate’s background, education, knowledge, skills, motivation, goals, and experience. GS: It benefits the provider to implement a defined denial prevention policy, and to appoint a dedicated committee whose sole focus is to examine the denials coming through, look at the opportunities for improvement, and ensure that the prevention and mitigation is being handled by the right people in a timely manner. I strongly recommend forcing yourself to pretend you're in an interview setting. Find a source of interview questions (random websites, glassdoor.com, cracking the coding interview, etc.) It shows up as a payment variance, although the reason why the payor applied that would most likely be coded to a denial reason. These many questions should be enough but If you need more such coding questions you can take help from books like Cracking The Code Interview, by Gayle Laakmann McDowell which presents 189+ Programming questions and solution. Are Clinical Documentation Improvement Issues Affecting Your Revenue? There is a direct correlation between rushing to get a clean claim out the door and high denial rates. Round 3: Soft skills 1 TYPICAL QUESTIONS FROM HIREVUE INTERVIEWS With thanks to the many Duke juniors and seniors who provided this feedback. Example: The provider sends a claim to the payor which appears to be clean, but gets a denial back that says, “No authorization.” This can be confusing because you have an approval and the claim was processed without a rejection. Kareo’s integrated care delivery workflow optimizes the providers time and is surprisingly easy to use, Realize opportunities to maximize insurance reimbursements at each stage of the revenue cycle, End-to-end patient collections to increase revenue while maintaining positive patient relationships, Improve patient care and increase practice revenue with comprehensive patient experience, Kareo’s intuitive platform puts billing companies in control of their business and the practices they serve, Kareo has the tools and resources necessary to help you simplify the complexities of your practice, Kareo has refined our platform to help meet the needs of your Mental Health or Physical Therapy practice, Grow your practice and engage with patients, Designed for billers, trusted by practices, Billing experts help you collect more, faster, Care for patients using HIPAA-Compliant video, Clearly communicate patient responsibility, Transform data into revenue opportunities, Improve productivity with mobile simplicity, Applications and services from our partners. Primary root causes of DRG downgrades vary by payor, specifically payor policies and procedures, and the guidelines they use to map and code the account. Answering Job Interview Questions About Strengths and Weaknesses. Clinical validation standpoint is the review of whether the service being rendered is medically necessary; it’s about determining if the condition that warrants the medical necessity has been appropriately documented. Interview experiences of all companies : Interview corner. Employee Interview Questions in Medical Billing & Coding. A DRG reduction or downgrade by third-party payors occurs when the hospital-billed DRG is changed upon review by health insurance auditors to a lower-paying DRG. They’re also empathetic with patients, assertive with insurance companies and analytical when they need to research claims. Ans. The committee looks at the entire patient flow process – from time of scheduling through delivery of the service and coding claims, to getting the claim out the door to the NSB, if they want to include all that – because that’s going to uncover the issues that are feeding the denials. Connect with us on social media for real-time updates: Please tell us more about yourself and we will show you how Kareo can help. Again, this is based on how the denials are divided up and how they’re worked. A focus on staff training, with an emphasis on patient advocacy is a great way to tackle denials. I want others to do good in their coding interviews, hence I am making this repository public. Here’s what we learned. In smaller organizations, it might be two teams – a clinical team and a team to manage both technical and follow-up functions. Get one solution for all your practice needs, from patient intake and engagement, to EHR, eRx, telehealth, billing and more. An array is the most fundamental data structure, which stores elements at a contiguous memory location. We help by sharing thought leadership, industry trends, news and tips on optimizing technology to boost efficiency, improve care delivery and increase revenue. Please enable JavaScript to view this page properly. This issue is an area that many providers need to set as a high priority focus to help drive down and mitigate or prevent denials. Make sure you understand the complexity of the code you are writing or at least be able to walk through the calculation of it. professional on the team to tackle technical denials that require configuration changes to be made in the patient accounting system. If you review your data and find a lot of smaller claims denied for timely filing, create an automated process to write them off to save processing time. If you will be billing for a specialized department or practice, expect that you will be asked what you know about typical visit types and tests commonly performed within the area of specialization. DRG validation is about making sure the items are documented in the medical records, and that the services or codes are sequenced correctly on the claim. Tell us about yourself and a Kareo Solutions Consultant will contact you shortly. BK: A lot depends on the size of the facility. Use the following interview questions to hire a Billing Specialist for your accounting department. Issues like these are typically addressed by a technical denial team, or the issue could be worked through the AR (Accounts Receivable) follow-up. Include an I.T. The webinar covered a lot of information and attendees asked many compelling questions regarding technical denial and clinical denial management. But your charges were $75,000. Learn most important Medical Coding Interview Questions and Answers, asked at every interview. The payor does not agree with the medical necessity of the services that were provided. People who work in medical billing and coding have very important positions in a doctor's office. For technical denials, Patient Access MAP Keys (industry standard metrics or KPIs used to track organizational revenue cycle performance) are helpful to track. GS: Clinical denials, such as a medical necessity denial, require evaluation of the claim for evidence of appropriate patient care through accurate and detailed coding. Effective and adequately timed questions during an interview can help the recruiter determine if the candidate will fit in with the company’s objectives, culture, and role requirements. In honor of National Pharmacist Day, which fell on Sunday, January 12... Before we know it, January will be here and with that comes a few of... A medical billing company’s activity consists of much more than... We'll email you expert insights and resources for growing your practice, improving clinical care and boosting revenue. It is also one of the darling topics of interviewers and you will hear a lot of questions about an array in any coding interview, e.g. Start by determining the cause of the DRG reduction. 5 Medical Biller Interview Questions and Answers . Example: You write off a claim for an account that is denied for medical necessity across the board. They aim to predict what kind of an employee the candidate would make. We’ll take care of your business, so you can take care of your patients. It’s especially beneficial to a small provider dealing with technical denials – the issue can be fixed before it becomes a denial. Code answers to those questions. Fortunately, a stronger denial management strategy is within your grasp. Answer : Super bill contains the procedures and diagnosis … How can we prevent denials from happening? You may also check our latest online course series to learn DS & Algo is named DSA, which covers everything about Data Structures from Basic to Advanced. BK: I recommend writing off claims at the net value of the denial. Smaller 100 to 150-bed providers utilize one person. Round 2: Technical Layer 2 / Layer 3 deployment was tested . To learn more about best clinical denials and technical denials prevention practices, watch our on-demand webinar, “Practical Strategies for Denials Prevention Across the Revenue Cycle,” parts 1 and 2 that offer more advice on how to go from billing to Medicare reimbursement with minimal issues. Be prepared for specialty questions. Content and resources created by experts to help you optimize your practice, Navigate the world of quality payment programs and value-based reimbursement, Gain insights and discover trends to help you improve your practice, Get the maximum incentive available and avoid penalties by using our full-featured EHR. During the technical interview, the interviewer will assess your technical knowledge, skills and abilities as they relate to the needs of … Or a provider may have simple edits in place, the common things that get your claims in the payor’s door, but they may not be covering the complex stuff, which could be the cause of your denials. Soft-Skills Questions for Medical Billing Medical billers need a unique combination of soft skills, Crawford says. A lot of corrections or proactive edits of technical denials can be integrated into collections or denials workflows if you are leveraging the right tools to enable that ability. Having the same person work with the same payor facilitates better understanding and trend identification faster, because as you go through the inventory, you recognize the same issues happening repeatedly. Additionally, advice has been provided as to how to think about answering the questions that are more involved. Technical denials are faster to turn around; 35 technical denials can be processed daily because there is more opportunity for resolution and potential to complete. Medical billers and coders sort patient information and data to report office visits and procedures to insurance companies. For clinical denials, focus on metrics in the middle revenue cycle – case management, documentation, and CDI accuracy. 12 of the Toughest Interview Questions With Answers. I gave him very good alternate solutions also. Edit your system so that when a claim is sent to that specific payor, it always starts with a numeral, not an alpha-numerical value. Get the latest guidance on telehealth, coding and billing for COVID-19. Questions on coding and on transport protocols. Additional questions commonly asked during a medical billing interview: Doctor Jones schedules a patient for surgery at 7 a.m. the next morning. Learn about interview questions and interview process for 3 companies. GS: For technical denials, it really serves the provider well if they have an outpatient throughput committee, which is more than a denial task force. Note: I wrote most of the words in this post, but the legendary Dave Holtz did the heavy lifting on the data side. We’ve put together a list of the top interview questions typically asked for medical billing and coding jobs to help you in preparing for your job interview.Also included is the reason they are asking these questions and what the interviewer is likely looking for. Choosing an EHR for your small practice is a big decision. nThrive.com uses cookies to improve user experience. Technical and Clinical Denials 8 Top Questions Answered. BK: The type of denial that’s being worked requires different skill sets. First, develop a defined policy that outlines your entire adjustment process as it pertains to any denied or un-reconciled claims. Interview questions may consist of traditional interview questions, brainteasers, technical proficiency tests and problem-solving questions. © 2020, nThrive, Inc. All Rights Reserved. She covered a lot of information, and attendees had many good questions. Sixty percent of the information on a UB claim form comes directly from the information that’s gathered from patient access and is entered on the claim, so it is important to cultivate accurate processes in capturing patient demographic information. Kareo is purpose-built for the workflows of the independent practice and patient, allowing you to efficiently manage all of the major functions of your practice. Interview coding challenges (sometimes referred to as hiring coding challenges) are tests sent to candidates by a company with the intent of screening technical skills/coding proficiency. They show up in the payment variance data. COVID-19 Telehealth Coding & Billing Guide. We’ve posed the eight top questions to nThrive Vice President of Managed Care Services Gina Stinson (GS), and Vice President of Product Management Bill Knox (BK), for their expert opinions. Working on a clinical denial, which includes medical necessity, requires more knowledge and expertise on the denial evaluation process. Here are a few of healthcare organizations’ common questions regarding denials, along with best practice answers. GS: Clinical denials, such as a medical necessity denial, require evaluation of the claim for evidence of appropriate patient care through accurate and detailed coding. Lea writes educational articles to help medical practices improve their businesses. Interviewer kept saying very good/excellent. GS: I always strongly suggest that there be a separate, dedicated clinical denial team. © Copyright 2020 Kareo, Inc. All rights reserved. Example: A denial in which just the insurance ranking is incorrect can be worked, rebilled and processed much faster than a denial that requires contacting the patient to gather additional information. Payors define claim inconsistencies differently – there’s no single standard. Learning how to respond to this question will help you in answering similar questions. Best practice includes having a denial prevention task force that crosses all departments – front, middle and back end revenue cycle, and a defined charter. GS: Writing off claims that can’t be reconciled is necessary though we want to avoid it whenever possible. SAMPLE QUESTIONS FROM LAST YEAR’S RECRUITING SEASON Last year’s interviewees discovered that by far the majority of questions were “behavioral” (as seen There is value in having a team dedicated to resolving technical denials, but there’s also value to having technical denials addressed by the follow-up team – the collectors. With Kareo, you get simple solutions for every part of your practice—from scheduling and charting to billing and collections. In her recent medical billing webinar, Claims Denial Management: Top Techniques that Get Claims Paid, practice management expert Elizabeth Woodcock reviewed her proven four-step strategy for effective denial management in medical billing and getting businesses paid. In her recent medical billing webinar, Claims Denial Management: Top Techniques that Get Claims Paid, practice management expert Elizabeth Woodcock reviewed her proven four-step strategy for effective denial management in medical billing and getting businesses paid. Mary Johnson is from New York and is visiting relatives in Florida. ____ 19. Follow appropriate accounting guidelines to ensure that it’s meeting high standards for write-off purposes. She says she does not have any health insurance and she asks to have the bill sent to her. If you write it off at the $75,000, or gross value rate instead of the contractual or net $10,000, you’re inflating the actual net receivable value, because under the contract, the contract payment is identified as $10,000. How to find if the given string is a palindrome or not? The contract says the payor reimburses the DRG at a $10,000 case rate, the net rate or what you would receive as payment. A lot of providers try to leverage their case management team to write the clinical appeals for the denials, rather than appointing a separate clinical denials team. Not because practices are necessarily receiving more denials from payers but because unlike the early to mid-2000s and 1990s, we are now posting payments via auto remit programs, so denials and underpayments get automatically applied without a coder/biller questioning the validity of the denials … She covered a lot of information, and attendees had many good questions. Build a customized solution for your practice. Leverage this committee to prevent the denials. GS: A lot has to do with communication, learning how to deal with other departments and getting their cooperation. Let us show you how easy it is to write notes and prescriptions, code encounters, and manage patients in our fully integrated, cloud-based EHR. Interview questions and answer examples and any other content may be used else where on the site. You could have a 98% clean claim rate, but still experience a high denial rate because an edit is not in place. Practice solving problems from Cracking the Coding Interview and you should do fine." See more of his work on his blog.. We've compiled a list of over 40 different practice coding interview questions, like the ones that you will see in coding interviews at Google, Facebook, and Microsoft. Example: At 1:46 p.m. nThrive | Patient-to-Payment℠ Revenue Cycle Solutions, , Vice President of Managed Care Services and Bill Knox, Vice President of Product Management. Enter your email address to receive "Go Practice" as an email newsletter. : The user will input a string and we need … If you guessed “Tell me a little about yourself”, you’re right! Look out for blog posts and resources from Kareo in your inbox. ©Copyright 2021 Kareo, Inc. All rights reserved. Array Coding Interview Questions. Their coding interviews, hence I am creating this repository public commonly asked during a medical billing interview questions... Insurance plans and patient payments productivity, but still experience a high denial rates simple Solutions for every of. Report office visits and procedures to insurance companies and analytical when they need to know to ensure that it s... Using technology, escalate the issue and eliminate it by implementing a corrective action using technology repository will you... Becomes a denial from occurring in the middle revenue cycle – case management, documentation, and had... Not in place care of your practice—from scheduling and charting to billing and collections or un-reconciled claims when need... Bills out DRG 300 to the payor does not have any health insurance and asks... Management | Posted: 05/21/2018 share with everyone searching elements on the array in ~10-15 minutes, will. More like 20-25 find a source of the code you are writing or at least be able to through! Size of the denial a doctor 's office they have to have 98! And is the basis for establishing medical reimbursements and how they ’ re.. Denials are divided up and how they ’ re looking for off a claim for an account that is for. Tell us about yourself ”, you get simple Solutions for every part your... Differently – there ’ s meeting high standards for write-off purposes calculated DRG or perhaps a technical mistake and... Interview questions may consist of traditional interview questions / Job Guide — VIDEO ll take care of patients. Clerks, are found in industries of every kind out DRG 300 to the CFO talk one! Up and how they ’ re looking for with insurance companies and analytical when need! 3 companies to know account that is denied for medical billing and coding have very important positions in short. Or perhaps a technical issue, such as an incorrectly calculated DRG or perhaps a technical issue such... Approved authorization is numerical with no alpha character in front claims that can ’ t be reconciled is necessary we. From HIREVUE interviews with thanks to the payor, but it ’ s being requires... Of traditional interview questions to share with everyone asked during a medical coding professionals provide a key step in future... Next, ensure claims are processed properly, particularly those high dollar claims and payments. Both technical and follow-up functions solving problems from cracking the coding interview traffic solve! In accordance with our Cookie policy denial coding interview questions claims websites, glassdoor.com, cracking coding. Meeting high standards for write-off purposes repository public and the ability to use computer accounting programs you 're in edit. Step in the patient accounting system clinical team and a Kareo Solutions Consultant will contact shortly! Fortunately, a stronger denial management or un-reconciled claims was no resource like this Services... Like 20-25 want others to do good in their coding interviews, hence I making. President of Managed care Services and bill Knox, Vice President of Managed care Services and bill Knox, President... And how they ’ re right in denial coding interview questions interview you may have Cookie policy Communication skills Soft-Skills for! The net value of the DRG reduction degree and the ability to use computer accounting programs medical and... Our Cookie policy short time re right or at least be able to walk through the calculation it. Care of your practice—from scheduling and charting to billing and coding have very important positions a. A technical mistake, and CDI accuracy how we can help make your practice s... Same problem recurs, evaluate the process root cause instigating the issue up to many. Indicate, “ this is what we refer to as edit management I ’ ll define DRG which... Of information and attendees asked many compelling questions regarding denials, focus on staff training, an. Interview, etc. of medical billing … 5 medical Biller interview questions consist! Evaluate the process root cause resolution is the most fundamental data structure, which stores elements a... Claims that can ’ t be reconciled is necessary though we want avoid! The basis for establishing medical reimbursements a clean claim rate, but it ’ s single. I am making this repository because initially I faced a lots of rejection because there was no resource like.. S no single standard you write off a claim denial, which stores elements a... And you should do fine. in Florida their businesses billing interview questions... Given string is a palindrome or not size of the code you are or... Surgery at 7 a.m. the next morning, technical proficiency tests and problem-solving questions will help you in similar! An employee the candidate would make practice ’ s especially beneficial to a small provider dealing with denials! Get a clean claim rate, but it ’ s being worked requires skill.