RCM Interview Questions

An eligibility denial occurs when the payer determines that the patient was not covered, not active, or not eligible for the billed service on the date of service.

I would verify the provider’s status through the payer’s provider portal, enrollment or network department, directory where appropriate, or formal payer confirmation. I would conf…

I would verify the patient's coverage for the date of service, compare payer and demographic information, review COB, and determine whether the claim needs correction, rebilling t…

Medicare provider enrollment is the CMS process used to establish eligible providers and suppliers for Medicare billing privileges, generally through PECOS or the applicable CMS e…

A coordination of benefits denial occurs when the payer cannot process the claim correctly because the patient's primary and secondary insurance order is missing, incorrect, or no…

PECOS is CMS’s online Medicare enrollment management system. Providers and suppliers can use it to submit enrollment applications, update enrollment information, upload supporting…

A provider enrollment denial occurs when the payer does not recognize the rendering or billing provider, group, location, specialty, or affiliation as properly enrolled for the se…

Medicaid provider enrollment is the process of registering and screening providers to participate in a state Medicaid program. It varies because each state administers its own Med…

A non-covered service denial occurs when the payer determines that the billed service is excluded, not a covered benefit, outside policy criteria, or otherwise not payable under t…

I would verify the provider's enrollment, group affiliation, effective date, specialty, location, and payer records before deciding whether the claim needs correction, retroactive…