study guide chapther 9 module 150-1
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37 terms
Terms | Definitions |
|---|---|
 Time limits sstated in individual health insurance policies about an insurance company's obligation to pay benefits are the for all insurance companies. | F |
| THER IS STANDARDIZATION OF FORMAT FOR THE EXPLANATION OFBENEFIT DOCUMENT FOR ALL PRIVATE INSURANCE CARRIERS | false |
| The insurance industry is proctected by a special exemption fromthe Federa Trade commission (FTC) | r |
| Insurance companies are rated according to the complaints recived aabout them. | r |
| Inquiries about insurance claims be in writind or by telephone | true |
| approximately 50% of individuals pursue appeals on a denied insurance claiim. | t |
| in any type of overpayment situation always cash the third-party payer's check and write a refund check payable to the originator of the overpayment. | true |
| if the povider is notified by a commercial insurance carrier that an overpayment has been made investigate the refund request. | true |
| A Level 1 Medicare redetermination (appeal) may by made either by telephone in writing in or by submitting a CMS-2007 form. | true |
| A peer review is usually done before the appeal process | flase |
| Appeal decisions on Medicare unassighned insurance claims are sent to the patient. | 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 insureance company and the company igores claims and exceeds time limits to pay a claim it is prudent to contact the ---------------------- | ...state insurance commissioner |
| The document together with the payment voucher that is sent to a physician who has accepted assignment of benefits is refered to as an ---------- | ... |
| when receiving payment from a private insurance carrier check the amount of payment on the EOB with in ------------------ | ... |
| An insuance claims register provides a-------------- | ... |
| Pending or resubmittied insurance claims may be tracked through a ------------------ | ... |
| There are several ways to file pending insurance claims. what is the best way to file so that timely follow-up can be made? | ... |
| A follow-up effort made to an insurance company to locate the status of an insurance claim is called a/an------------ | ... |
| If an insurance claim has been lost by the insurance carrier the procedure(s) to follow is to-------------- | ... |
| An example of a technical error on an insurance claim is ------------------ | ... |
| An insurance claim with an invaild procedure code would be--------------- | ... |
| What should you do if an insurance carrier requests information about another insurance carrier?----------- | ... |
| An insurance claim with a bundled service would be------------- | ... |
| An insurance claim for which prior approval was not obtained would be ------------------ | ... |
| What should be done if an insurance claim denial is received because a billed service was not a program benefits? | ... |
| What should be done if an insurance company denies a service stating it was not medically necessary and physician believes it was? | ... |
| When downcoding occurs payment will | ... |
| If an insurance company admits that a patient signed an assignment of benefits document and that itinadvertently paid the patient instead of the physician the insurance company should---------- | ... |
| The total number of levels of redetermination that exist in the Medicare program is | ... |
| The level of appeal in the Medicare program is | ... |
| The correct method to send documents for a Medicare reconsideration (Level 2) is by----------- | ... |
| A request for a Medicare admininistrative law judge hearing can be made if the amount in controversy is at least--------------- | ... |
| How many levels of review exist exist for Tricare appeal procedures?------------- | ... |
| TRICARE appeals are normally resolved whithin | ... |
| In a TRICARE case, a request for an independent hearing may be pursued if the amount in question is---------- | ... |
| An insured person cannot bring legal action against an insurance company until -----------days after a claim is submitted to the insurance company. | ... |
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