Skip to main content

RCM Q&A 1 Claim in Process : Top RCM Technical Questions and Answers with Sample notes Format for: Claim in process

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: May I know the patient's effective and termination date

Step11: When shall I call back to you

Step12: May I know the claim#

Step13: May I know the call ref#

Sample Notes Format : 

Checked no status found on Clearinghouse and Insurance web portal hence called insurance and spoke with Sam for Dos mm/dd/yyyy Stated claim was received on mm/dd/yyyy and it is in process. The rep informed me it would take 10 business days to complete processing. Clm#12345. Ref# 54321

Please forward this blog to any of your friends who are scheduled to attend an important interview.







 

Comments

  1. Medical bill codingApril 12, 2022 at 3:24 AM

    insurance billing and coding
    Get Access To Our Free On-Demand Revenue Cycle Management Webinar. Billing Your way is Prestige Medical Consultants.
    View our Webinar to unlock the capabilities of real-time benchmarking of your Analytics. we help our clients providing solutions with
    Advanced Technology.

    ReplyDelete

Post a Comment

Popular posts from this blog

What is QMB / MQMB stands for?

In Medical billing or Healthcare industry The term QMB stands for Qualified Medicare Beneficiary & MQMB stands for Medicare Qualified Medicare Beneficiary. The term "QMB" or "MQMB" on the form indicates the client is a Qualified Medicare  Beneficiary (QMB) or a Medicaid Qualified Medicare Beneficiary (MQMB). The Medicare Catastrophic Coverage Act of 1988 requires Medicare premiums, deductibles, and coinsurance payments to be paid for individuals who meet the following criteria:  Important: Clients limited to QMB are not eligible for THSteps or THSteps-CCP Medicaid benefits.  Note: Clients eligible for STAR+PLUS who have Medicare and Medicaid are MQMBs. Medicaid reimburses for the coinsurance and deductibles as well as Medicaid-only services for the MQMB client. QMBs do not receive Medicaid benefits other than Medicare deductible and coinsurance liabilities. MQMBs do qualify for Medicaid benefits not covered by Medicare in addition ...
7 comments
Read more

Key Performance Indicators (KPIs) for Successful Revenue Cycle Management (RCM) in Healthcare Organizations

 Revenue Cycle Management (RCM) is an essential process for healthcare organizations to ensure that they receive timely and accurate payments for the services they provide. Here are some of the key performance indicators (KPIs) metrics that healthcare organizations should track as part of their RCM process: Gross Collection Rate (GCR): This metric measures the percentage of charges that a healthcare organization collects from patients and insurance companies. It is calculated by dividing the total payments received by the total charges billed. Net Collection Rate (NCR): The NCR measures the percentage of expected payments received by the healthcare organization after accounting for contractual adjustments, bad debts, and other adjustments. It is calculated by dividing the total payments received by the total expected payments. Days in Accounts Receivable (DAR): This metric measures the average number of days it takes fo...
Post a Comment
Read more

What is W-9 form? Why it is required for Medical Billing.

W-9 Form W-9 is Internal Revenue Services (IRS) request for Tax Payers identification number, mainly its used for third parties to collect ID information like Name, Address to help file information returns with IRS. Also its is used to help payee avoid backup withholding. It is required for your name, Address and SSN number or employer identification number. When your giving out W-9 form be caution, because W-9 form contains sensitive information’s. Why Insurance Company ask W-9 Form from hospital or clinic etc., Because medical billing is cycle indirectly or directly insurance company’s are working for hospital or clinic etc., for them we need to report SSN number / business tax id. As far as       W-9 is form is concern it is straight forward with the all the above mentioned information, also they need to pay to address, or to update their records, or to check / update records. Note: W-4 Form is used by employer ...
9 comments
Read more