certified medical biller Interview Questions and Answers

1. What is the role of a medical biller?

   • Answer: A medical biller is responsible for submitting and following up on claims to insurance companies and patients to ensure timely payment for medical services rendered. This includes preparing claims, verifying patient insurance coverage, handling denials and appeals, and managing patient accounts receivable.

2. Explain the difference between ICD and CPT codes.

   • Answer: ICD codes (International Classification of Diseases) classify diseases and medical conditions. CPT codes (Current Procedural Terminology) describe medical, surgical, and diagnostic procedures performed by physicians and other healthcare providers. ICD codes are used for diagnoses, while CPT codes are used for procedures.

3. What is a clean claim?

   • Answer: A clean claim is a claim that contains all the necessary information for processing without requiring additional information or clarification from the biller or provider. This includes accurate patient information, proper coding, and supporting documentation.

4. What is an Explanation of Benefits (EOB)?

   • Answer: An Explanation of Benefits (EOB) is a statement sent by an insurance company to a patient and/or provider explaining what services were billed, what the insurance company paid, and what the patient's responsibility is (copay, deductible, etc.).

5. How do you handle a denied claim?

   • Answer: I would first review the denial reason code to understand why the claim was denied. Common reasons include incorrect coding, missing information, or lack of authorization. Then, I would either correct the error and resubmit the claim, or if necessary, I would appeal the denial with supporting documentation.

6. What is the importance of accurate coding?

   • Answer: Accurate coding is crucial for ensuring proper reimbursement for services. Incorrect coding can lead to claim denials, underpayment, or even fraud investigations. It also ensures accurate data for healthcare statistics and research.

7. What software or systems are you familiar with for medical billing?

   • Answer: [List specific software and systems – e.g., "I am proficient in using [Software Name] and have experience with [Other software/systems]. I am also familiar with electronic health record (EHR) systems such as [EHR system names]."]

8. Describe your experience with medical billing procedures.

   • Answer: [Describe your specific experience, including the number of claims processed, your role in the process, and any notable achievements or challenges you've overcome. Be specific and quantify your accomplishments whenever possible.]

9. How do you stay updated on changes in medical billing regulations and coding?

   • Answer: I regularly review updates from organizations like the AMA (American Medical Association), the Centers for Medicare & Medicaid Services (CMS), and professional medical billing associations. I also participate in continuing education courses and webinars to stay informed about changes in coding and regulations.

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