Medical Device Reimbursement Specialist Interview Help

Overview of Certifications, Educational Background, and Industry Qualifications

To excel as a Medical Device Reimbursement Specialist, candidates should possess a blend of educational qualifications, certifications, and practical experience. Here’s a brief overview of the most relevant credentials:

Required and Recommended Certifications

• Certified Professional Coder (CPC): Offered by the AAPC, this certification is highly recommended as it demonstrates expertise in coding, which is essential for understanding medical billing and reimbursement processes.
• Certified Coding Specialist (CCS): Offered by AHIMA, this certification focuses on hospital and ambulatory care coding, adding value to a candidate’s profile.
• Certified Medical Reimbursement Specialist (CMRS): This certification from the American Medical Billing Association (AMBA) covers advanced billing and reimbursement skills.
• Certified Professional Biller (CPB): Also offered by the AAPC, this certification focuses on the billing aspect of medical services, which is crucial for reimbursement.

Educational Background

• Bachelor’s Degree in Healthcare Administration, Health Information Management, or a related field: This provides foundational knowledge in healthcare systems, policies, and management.
• Advanced Degrees (e.g., Master’s in Health Administration or Business Administration): While not mandatory, these degrees can enhance leadership and strategic capabilities.

Industry Qualifications

• Experience in Medical Billing and Coding: Practical experience in coding and billing is crucial for understanding the nuances of reimbursement.
• Familiarity with Healthcare Regulations: Understanding Medicare, Medicaid, and private insurance regulations is essential.
• Proficiency in Medical Software: Experience with Electronic Health Records (EHRs) and billing software like Epic, Cerner, or Meditech can be advantageous.

Detailed Interview Questions and Comprehensive Answers

Technical Questions

What are the key components of the revenue cycle in healthcare, and how do they relate to your role as a Medical Device Reimbursement Specialist?

Answer:

• Key Components: The revenue cycle in healthcare includes patient registration, charge capture, claim submission, payment posting, and accounts receivable follow-up.

  • Patient Registration: Accurate patient information is crucial for successful claims processing.
  • Charge Capture: Ensures all services provided are recorded and billed.
  • Claim Submission: Accurate coding and timely submission are essential for reimbursement.
  • Payment Posting: Ensures payments are posted correctly to patient accounts.
  • Accounts Receivable Follow-Up: Involves managing denied claims and outstanding payments.

• Relation to Role:

  • As a Medical Device Reimbursement Specialist, you ensure that medical devices are appropriately coded and billed, impacting charge capture and claim submission.
  • You work closely with billing teams to resolve denials, impacting accounts receivable.

• Example Scenario: When a claim for a new medical device is denied due to incorrect coding, you would:

  • Analyze the denial reason: Check if the denial was due to a coding error or lack of documentation.
  • Rectify the issue: Update codes or gather additional documentation.
  • Resubmit the claim: Ensure timely re-submission to avoid revenue loss.

• Best Practices:

  • Regular Training: Stay updated with coding changes and payer policies.
  • Collaboration: Work closely with clinical staff to ensure documentation supports coding.

• Common Pitfalls to Avoid:

  • Ignoring Denial Trends: Repeated denials for similar issues should prompt process review.
  • Inadequate Documentation: Ensure all device usage is well-documented in medical records.

• Follow-Up Points:

  • How do you prioritize tasks within the revenue cycle?
  • Can you describe a time when you improved the efficiency of a revenue cycle process?

Behavioral Questions

Describe a time when you had to work with a team to resolve a complex reimbursement issue. What was your role, and what was the outcome?

Answer:

• Context: At my previous job, we faced a significant backlog of denied claims for a newly introduced surgical device.

• Role:

  • Team Collaboration: I led a team comprising coding specialists, billing staff, and clinical documentation experts.
  • Analysis: Conducted a root cause analysis to identify common denial reasons.
  • Process Improvement: Developed a checklist to ensure all necessary documentation was submitted with claims.

• Outcome:

  • Improved Approval Rate: Our efforts reduced the denial rate by 30% within three months.
  • Increased Revenue: Ensured timely reimbursement, improving cash flow.

• Reasoning:

  • Why it worked: Addressing the issue collaboratively allowed us to leverage diverse expertise.
  • When to adapt: If the issue persists, consider further training or process modifications.

• Alternative Considerations:

  • Implement automated systems to flag potential errors before submission.
  • Regularly review payer feedback to pre-emptively address common issues.

• What Not to Do:

  • Do not ignore input from team members; diverse perspectives can uncover overlooked issues.
  • Avoid rushing to submit claims without thorough checks; this can lead to repeated denials.

• Follow-Up Points:

  • What challenges did you face in gaining team buy-in?
  • How do you ensure continued collaboration and communication in a team setting?

Situational Questions

If a major payer changes its reimbursement policy for a medical device you are responsible for, how would you handle the situation?

Answer:

• Initial Response:

  • Policy Review: Thoroughly review the new reimbursement policy to understand changes.
  • Impact Analysis: Evaluate how these changes impact current billing practices and reimbursement rates.

• Action Plan:

  • Stakeholder Communication: Inform relevant departments (billing, coding, clinical) about the changes.
  • Training Sessions: Conduct training sessions to update staff on new coding or documentation requirements.
  • System Updates: Ensure billing software is updated to reflect policy changes.

• Example Scenario: A payer reduces reimbursement rates for a device unless specific outcome data is provided.

  • Data Collection: Collaborate with clinical staff to gather necessary outcome data.
  • Documentation Enhancement: Ensure all claims include required data to meet new criteria.

• Reasoning:

  • Why it works: Proactive communication and training reduce errors and denials.
  • When to adapt: If immediate implementation is not possible, prioritize high-impact areas.

• Common Pitfalls to Avoid:

  • Delayed Response: Failing to act quickly can lead to revenue loss.
  • Inadequate Training: Insufficient training can result in errors and denials.

• Follow-Up Points:

  • How do you prioritize changes when multiple payers update policies simultaneously?
  • Can you provide an example of a successful policy change implementation?

Problem-Solving Questions

A claim for a high-cost medical device has been denied due to lack of medical necessity. How would you approach resolving this denial?

Answer:

• Denial Analysis:

  • Reason Identification: Review the denial notice to understand the specific reason for lack of medical necessity.
  • Documentation Review: Check if all necessary clinical documentation was provided and supports the claim.

• Resolution Strategy:

  • Clinical Collaboration: Work with the prescribing physician to obtain additional clinical evidence supporting medical necessity.
  • Appeal Preparation: Prepare a comprehensive appeal including supplementary documentation and a letter from the physician explaining the necessity.

• Example Scenario: A prosthetic device claim is denied because the payer deems it not medically necessary.

  • Additional Evidence: Gather patient history, outcome studies, and physician’s justification.
  • Successful Appeal: Present a compelling case that leads to claim approval on appeal.

• Reasoning:

  • Why it works: Detailed documentation and expert opinions strengthen the appeal.
  • When to adapt: If initial appeal fails, consider alternative reimbursement channels or patient assistance programs.

• Alternative Considerations:

  • Explore payer guidelines to adjust future claims submissions.
  • Implement pre-authorization checks to prevent similar denials.

• What Not to Do:

  • Do not resubmit the claim without addressing the denial reasons; this leads to repeated denials.
  • Avoid neglecting payer-specific guidelines; each payer may have unique requirements.

• Follow-Up Points:

  • How do you balance the urgency of appeals with the accuracy needed for success?
  • Can you discuss a time when an appeal was initially denied and how you eventually resolved it?

By preparing with these questions and comprehensive answers, candidates can demonstrate their expertise and problem-solving abilities, making them strong contenders for the Medical Device Reimbursement Specialist role.