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INTRODUCTION TO MEDICAL BILLING AND CODING QUESTIONS AND ANSWERS WITH SOLUTIONS 2024
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INTRODUCTION TO MEDICAL BILLING AND CODING QUESTIONS AND ANSWERS WITH SOLUTIONS 2024
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INTRODUCTION TO MEDICAL BILLINGAND CODING QUESTIONS AND
ANSWERS WITH SOLUTIONS 2024
What are medical coders? - ANSWER They translate healthcare provider's report of a patients visit into a
procedure and/or diagnosis codes for billing purposes.
What are medical billers? - ANSWER They submit the codes given by the medical coder as a claim for an
insurance company to determine payment for the services. It is their responsibility checking for accuracy
in transaction reports, creating bills for patients, creating formally correct claims, and collecting
payments
What is a claim? (Medical billing) - ANSWER Itemize list of procedures, services, and costs that is sent
from a healthcare provider to a payer to collect reimbursement for the provided services.
The medical biller receives _______ which explains what services and procedures the insurance
company paid for, analyze them, and then creates bills for patients. - ANSWER explanation of benefits
(EOB)
What does EOB stand for? - ANSWER explanation of benefits
What is an example of a medical biller's job? - ANSWER They take the procedural and diagnosis codes at
the medical coder has translated and creates aclaim from these using a form or a type of software
program. The biller that reviews the patient's insurance policy determine if the procedures and services
performed by the healthcare provider a covered by that patient's plan. The medical biller needs to make
sure that each code, and less each procedure listed on the claim, is actually billable, and since the claim
to the insurance company. The insurance company then performs an evaluation known as payer
adjudication, which determines the amount of the bill they will Reimburse the provider for, and then
sends this information back to the provider in the form of an EOB. The EOB explains the amount paid for
by the insurance company, as well as any obligation the patient may have. The biller then reviews the
EOB be for accuracy, as well as ensures that the charges and reimbursements correspond to the
providers agreement with the payer. If there is any balance owing by the patient, a patient statement will
need to be created and sent out to the patient. The biller also follows up with the patient for payment,
and in a non-pay situation, sends the bill for collections.
, How does a medical biller create a patients claim? - ANSWER Medical billers job starts once the medical
coder finishes their job. When a patients receives medical services from a healthcare provider they're
typically presents with a bull at the end of their services. The biller creates this bill by looking at the
balance (if any) the patients has. The biller MUST factor in the patients copay, deductible, and deducting
the amount covered by insurance.
Coders must complete their coding in ___ to ___ days. - ANSWER 2 to 5 days. 5 days MAX! Each office
has a specific lag time. Things run smoothly if these deadline are hit.
Why is medical coding needed? - ANSWER It's to translate what transpired in any exchange between a
patient and a healthcare provider in a uniform practice, MAINLY for the purpose of reimbursement for
healthcare services.
Every injury, diagnosis, and medical service there is a corresponding code.
True
False - ANSWER True
The codes in the medical office act as the universal language between doctors, hospitals, insurance
companies and clearinghouses, government agencies, and other health-specific organizations.
True
False - ANSWER True
Every code has the same guidelines and rules.
True
Fase - ANSWER False. Every code has its OWN set of guidelines and rules. This will affect the status of a
claim.
The code do not have to be accurate.
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