Medical Billing

 RCM Q&A 3 Duplicate Denial: Top RCM Technical Questions and Answers with Sample Notes Question: How do you work on – Duplicate Denial Answer : Step1: The status of a claim can be found on the insurance company's website, Through EOB, Correspondence,. Step2: Check-in the billing system, if you have any duplicate denial in the system. If yes check with the coding team. If it's a real duplicate adjust off the balance. If no Step3: Call the insurance company and ask the rep May I know the claim received and denied date and the Original claim status Step4: If the original claim is denied go by the denied scenario If it is paid go by the paid scenario and if it is in-process then go by the in-process scenario Step5: May I know the original and current claim#, Could you please send the copy of EOB( duplicate copy) Step 6: May I know the claim# and reference # If you need to answer all the above-mentioned steps with the interviewer   Sample Notes : Claim # Dos

RCM Q&A 2: Top RCM Technical Questions and Answers with Sample Notes  Question: How do you work on - Claim Denied for Authorization Same Question instead of denial Interviewer can ask the question like Missing/invalid/Authorization/Notification/Pre-certification etc.,   Answer : Step1 : The status of a claim can be found on the insurance company's website; but, for missing authorization denial scenarios, you must contact the insurance company for more information. Step2 : Provide Physician and Claim related information with the rep Step3 : Ask rep May I know the claim received and denied date Step4 : Ask why you required authorization for this service/cpt code and do they see any authorization on the file for another hospital claim Step5: If yes Step6: Could you please send the claim back for reprocess with that authorization and check the authorization effective and end date Step7: If No Step8: Can we get the retro authorization for this service Step9: If Yes Step 10:

RCM Q&A 1: Top RCM Technical Questions and Answers with Sample notes Format for Claim in the process: Interviewer Question: How do you work on  - In Process Claim Answer :  Step1: Check with the Clearing House to see if your claim has been accepted. Step 2: *Considering both Clearing House and Insurance Accept Check Claim Step3: *Considering - Insurance has not responded. After 15 days from the date of the Clearing House and Insurance acceptance. Step4: Claim Status can be located on the insurance website, however in our scenario consider there is no information about it. Step5: Call the Insurance Company Step6: Once you reached the Insurance Representative, after providing basic information about the claim. You need to ask the following questions May I know the Claim received date  Step7: May I know how many days it may take to process the claim Step8: If the received Date is more than 30 days then need to ask the below questions Step9: May I know the reason for the dealy Step10: