Practice Management Alert

A few questions can go a long way in helping you determine a biller's competence and experience

 Your practice's financial success depends on skilled and dependable new hires to help your billing office run smoothly - and asking the right questions up front can save you a lot of time and money down the line.
 
 Integrate this billing knowledge assessment into your interview process to help illuminate excellent candidates and better understand the strengths of your potential new employees. Billing Specialist Knowledge Assessment Questions Please answer all of the following questions to the best of your ability. Your answers will assist us in determining where we can best use your skills in our practice. 1. Explain the difference between a CPT code and an ICD-9-CM code. 2. A CPT code has ____ digits, and an ICD-9-CM code has ____ digits. 3. What are evaluation and management (E/M) codes? 4. List all the outpatient consultation codes. 5. Which two types of hospital E/M codes can you not bill for the same physician on the same day? 6. What is the difference between a consultation and a transfer of care? 7. How do payers define the "global package"? 8. What is "unbundling"? 9. How is the posting of a commercial insurance payment different from the posting of a PPO payment? 10. What is a "withhold"? Explain exactly how to post it in the computer system. 11. What is the difference between pre-certification and pre-authorization? 12. What is the difference between Regular Medicare and a Senior HMO in terms of reimbursement? 13. What does it mean to post payments by line item? Why is it so important to do so? 14. You should follow up on an unpaid Medicare claim at ____ days if the practice is participating and files electronically. 15. You should follow up on an unpaid non-Medicare claim at ____ days. 16. How would you handle the following EOB rejections or "$0.00 pays"?
 a) "Procedure not a covered benefit"
 b) "Patient not eligible on date of service"
 c) "Contract number does not match information on file"
 d) "Applied to deductible" 17. What is the minimum balance you think appropriate for a patient to pay under a monthly budget plan? 18. How would you set up a budget plan for a working 35-year-old mother who has not yet met her deductible? The account is 60 days old.  - Billing Specialist Knowledge Assessment provided at the America Medical Billing Association's annual conference by Mike Edmonds, owner and executive director of Physicians Financial & Management Services LLC in Cordova, Tenn. Questions and answers edited by Catherine Brink, CMM, CPC, president of HealthCare Resource Management Inc. in Spring Lake, N.J.


Billing Specialist Knowledge Assessment - Answer Key

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