RCM Specialist Interview Questions

A Claim Adjustment Reason Code, or CARC, explains the general reason a payer adjusted, denied, or assigned responsibility on a claim or service line.

If insurance cannot be verified electronically, I would first confirm that the patient and insurance information was entered correctly, then use alternate verification methods suc…

If a claim is rejected for an invalid subscriber ID, I would first verify the patient’s insurance card, eligibility response, and registration details to confirm the correct membe…

Individual enrollment establishes the healthcare professional with the payer, while group enrollment establishes the organization or practice. In many billing arrangements, the in…

A Remittance Advice Remark Code, or RARC, provides additional information that clarifies the payer's adjustment or denial reason.

A participating provider has a participation arrangement or contract with the payer or program under applicable terms, while a non-participating provider does not participate in t…

A corrected claim fixes claim data, a reconsideration asks the payer to re-review an adjudication, and an appeal is a formal challenge to a denial or payment decision under the pa…

Payer enrollment is the process of establishing a provider or organization in a payer’s billing system so claims and payments can be processed correctly. After credentialing, cont…

A corrected claim is usually appropriate when the original claim contains a fixable billing error such as an incorrect code, modifier, provider, diagnosis linkage, units, demograp…

The enrollment effective date is the date from which the payer recognizes the provider’s approved enrollment or participation for applicable billing purposes. It is critical becau…