The concept that every procedure or service reported to a third-party payer must be linked to a condition that justifies that procedure or service is called medical...
The administrative agency responsible for establishing rules for Medicare claims processing is called the...
Centers for Medicare & Medicaid Services (CMS)
Documentation submitted to an insurance company requesting reimbursement for healthcare services provided is called a health insurance...
Which organization is responsible for administering the Certified Medical Reimbursement Specialist certification exam?
Which clause is implemented if the requirements associated with preauthorization of a claim prior to payment are not met?
Data published in the Occupational Outlook Handbook indicate the job opportunities for health insurance specialists will increase by what percentage?
9% to 17%
Patients with health insurance may require _______ (prior approval) for treatment by specialists & documentation of post-treatment reports.
The process of reporting diagnoses, procedures, & services as numeric & alphanumeric characters on an insurance claim is...
If a patient is seen by a provider who orders a chest x-ray, which diagnosis should be linked with the procedure to prove medical necessity?
Shortness of Breath
The notice sent by the insurance company to the provider, which contains payment information about a claim, is the...
When an individual chooses to perform services for another under an express or implied agreement & is not subject to the other's control, the individual is defined as a(n)...
Employers are generally considered liable for the actions & omissions of employees as performed & committed within the scope of their employment. This is known as...
Third-party payer _______ review CMS-1500 claims to determine whether the charges are reasonable for payment.
Which type of insurance should be purchased by health insurance specialist independent contractors?
Errors & Omissions