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AIC 44 - Chapter 7
Terms in this set (17)
Most insurers require that a claim representative contact a claimant's treating medical provider within
24-48 hours of receiving a claim.
Controlling healthcare provider fees by negotiating discounts, developing billing guidelines, and auditing medical bills is an example of
During the medical investigation process, preexisting conditions should be
Investigated as thoroughly as possible because it is important to determine if they were significantly aggravated.
For workers compensation claims, some states require that employers provide a panel of medical providers for injured workers to use when selecting a treating provider. These states
Often have rules about the types of providers on the panel.
Independent medical exams and physician peers' retrospective reviews of treatment are two examples of
A claim representative is reviewing medical reports and bills for a workers compensation claim. In the representative's professional opinion, the treating physician is prescribing more tests and physical therapy sessions than would normally be warranted given the claimant's injury. The representative is concerned that a causation issue might be involved. What would be the most prudent next step for the representative to address in this situation?
Order an independent medical exam
A claim representative has been assigned a claim and is conducting the medical investigation. The representative has gathered medical bills, the loss notice, medical reports, hospital bills, witness statements, ambulance records, and the claimant's statement. What should be the representative's next step in investigating medical causation issues?
Organize the file material chronologically
Privacy includes the right to a reasonable expectation of confidentiality. The Federal Privacy Act of 1974 was passed to protect individuals against invasions of privacy by
A medical authorization for disclosure of information should include which one of the following types of information?
The specific expiration date of the authorization
Which one of the following describes the correct method for an adjuster to obtain medical information contained in an injured worker's medical records?
The adjuster obtains an authorization for disclosure signed by the patient.
A narrative report is similar to a medicolegal report in that the provider summarizes the course of treatment and
States a diagnosis.
Hospital records detail the patient's care and treatment while in the hospital. Which one of the following professionals is responsible for compiling the history and performing the physical examination?
The initial assessment is an important stage in the workers compensation claim process because it
Sets the parameters for the investigation and alerts management of potentially serious claims.
All of the following are steps in the medical investigation process for a claim, EXCEPT:
Determine the need for medical case management.
A construction worker was recently injured on the job and filed a workers compensation claim. During the medical investigation, the claim representative notices that the employee is never home when attempts are made to contact him. Also, the employee frequently misses doctor appointments. Which one of the following forms of fraud is most likely occurring?
The employee is working on the side while receiving workers compensation benefits.
One of the most common types of frauds in workers compensation claims involves an injured employee working on the side while collecting workers compensation benefits. Which one of the following would be the best indicator that this type of fraud may be occurring?
Frequently missed doctor's or physical therapy appointments
In order to achieve the strongest and most useful result from an independent medical examination (IME), the claim representative should request an IME when the claimant
Is at the point of the maximum recovery from the injury.
THIS SET IS OFTEN IN FOLDERS WITH...
AIC 44 - Chapter 1
AIC 44 - Chapter 2
AIC 44 - Chapter 3
AIC 44 - Chapter 4
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