HC21 Claims Questions And Answers With Verified Solutions
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Course
HC21 Claims
Institution
HC21 Claims
Which of the following best describes an insurance carrier's allowed charges?
-Fees a patient may be billed for after receiving a service
-Fees an insurance carrier is willing to pay for a particular service
-Fees a physician is willing to charge for a particular service
-Fees established by th...
HC21 Claims
Which of the following best describes an insurance carrier's allowed charges?
-Fees a patient may be billed for after receiving a service
-Fees an insurance carrier is willing to pay for a particular service
-Fees a physician is willing to charge for a particular service
-Fees established by the government as appropriate for a service - ✔️✔️Fees an
insurance carrier is willing to pay for a particular service
What does an insurance claim do?
-It allows the patient to sue the insurance carrier.
-It gives the patient a record of insurance pay-outs.
-It allows physicians and insurance carriers to communicate.
-It gives the physician a record of the patient visit. - ✔️✔️It allows physicians and
insurance carriers to communicate.
What type of violation is overcharging for medical supplies?
-Fraud
-Abuse - ✔️✔️Abuse
What is the name of the currently accepted Universal Claim Form for the medical office?
-Someone within an organization who commits fraud or abuse
-Someone within an organization who reports fraud to a third party
-A third-party insurance auditor
-Someone at an insurance agency who believes a physician is committing fraud -
✔️✔️Someone within an organization who reports fraud to a third party
How are Diagnosis Related Groups (DRGs) grouped?
-By diagnosis and procedure
-By patient demographic information
-By severity of diagnosis
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