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37 terms

study guide chapther 9 module 150-1

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STUDY
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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--------------
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Pending or resubmittied insurance claims may be tracked through a ------------------
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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------------
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If an insurance claim has been lost by the insurance carrier the procedure(s) to follow is to--------------
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An example of a technical error on an insurance claim is ------------------
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An insurance claim with an invaild procedure code would be---------------
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What should you do if an insurance carrier requests information about another insurance carrier?-----------
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An insurance claim with a bundled service would be-------------
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An insurance claim for which prior approval was not obtained would be ------------------
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What should be done if an insurance claim denial is received because a billed service was not a program benefits?
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What should be done if an insurance company denies a service stating it was not medically necessary and physician believes it was?
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When downcoding occurs payment will
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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
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The correct method to send documents for a Medicare reconsideration (Level 2) is by-----------
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A request for a Medicare admininistrative law judge hearing can be made if the amount in controversy is at least---------------
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How many levels of review exist exist for Tricare appeal procedures?-------------
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TRICARE appeals are normally resolved whithin
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In a TRICARE case, a request for an independent hearing may be pursued if the amount in question is----------
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An insured person cannot bring legal action against an insurance company until -----------days after a claim is submitted to the insurance company.
...