Ch 09: Receiving Payments and Insurance Problem Solving

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Insurance Handbook for the Medical Office Fordney Chapter 9: Receiving Payments and Insurance Problem Solving

T or F: Insurance companies are rated according to the number of complaints received about them.

true

If an insured is in disagreement with the insurer for settlement of a claim, a suit must begin within...

3 years

If a payment problem develops with an insurance company and the company ignores claims and exceeds time limits to pay a claim, it is prudent to contact the...

state insurance commissioner

A follow-up effort made to an insurance company to locate the status of an insurance claim is called a/an...

inquiry

An insurance claim with an invalid procedure code would be...

rejected (denied)

What should you do if an insurance carrier requests information about another insurance carrier?

provide the information

An insurance claim for a service that has been bundled with other services would be...

rejected (denied)

An insurance claim for which prior approval was not obtained would be...

rejected (denied)

What should be done if an insurance claim denial is received b/c a billed service was not a program benefit?

Send a statement to the patient with a notation of the response from the insurance company

What should be done if an insurance company denies a service stating it was not medically necessary and the physician believes it was?

Appeal the decision with a statement from the doctor

When downcoding occurs, payment will...

be less

If an insurance company admits that a pt signed an assignment of benefits document and that it inadvertently paid the pt instead of the physician, the insurance company should...

pay the doctor within 2-3 weeks and honor that assignment of benefits before they even try to get the money back from the pt

An insured person cannot bring legal action against an insurance company until __________ days after a claim is submitted to the insurance company.

60

Monitoring the activities of insurance companies and making sure that the interests of the policyholders are protected are the jobs of the insurance _______________.

commission

All requests of the insurance commissioner must be submitted in writing and include the _________ signature.

patient's

Overdue payment on an insurance claim is referred to as...

delinquent

An insurance claim that is processsed without following specific insurance carrier instructions is considered a/an __________ claim.

rejected

If the medical practice receives payment from an insurance company that is more than the contract rate, it is called a/an...

overpayment

Generally, if a bill has not been paid, the physician rebills the pt every __________ days.

30

If inadequate payment was received from an insurance company for a complicated procedure, the insuance billing specialist should file a/an __________ on behalf of the physician.

appeal

A request for a hearing before an administrative law judge (in a Medicare case) may be made if the amount still in question is $_______ or more.

$130

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