Matching
Match the following:
Premises:
Decision maker at the third level of a Medicare appeal, which includes a hearing
The method of documentation most widely used by physicians for record keeping
The second level of appeal for Medicare claims, during which these entities process reconsiderations of a carrier’s redetermination
The submission of additional clinical and other pertinent information to an insurance carrier to overturn a denied or downcoded claim
An objective, unbiased group of physicians that determines what payment is adequate for services provided
The examination and verification of claims and supporting documents submitted by a physician
The section of the law that governs refunds of overpayments where no contract language exists
The law that protects the interests of beneficiaries enrolled in private employee benefit plans
The chronological recording of pertinent facts and observations about a patient's health status
The first level of a Medicare appeal in which the carrier is asked to review its initial decision
Responses:
redetermination
appeal
Civil Practice and Remedies Code
peer review
Employee Retirement Income Security Act (ERISA)
audit
subjective, objective, assessment, plan (SOAP)
documentation
qualified independent contractors (QICs)
administrative law judge (ALJ)
Correct Answer:
Premises:
Responses:
Decision maker at the third level of a Medicare appeal, which includes a hearing
The method of documentation most widely used by physicians for record keeping
The second level of appeal for Medicare claims, during which these entities process reconsiderations of a carrier’s redetermination
The submission of additional clinical and other pertinent information to an insurance carrier to overturn a denied or downcoded claim
An objective, unbiased group of physicians that determines what payment is adequate for services provided
The examination and verification of claims and supporting documents submitted by a physician
The section of the law that governs refunds of overpayments where no contract language exists
The law that protects the interests of beneficiaries enrolled in private employee benefit plans
The chronological recording of pertinent facts and observations about a patient's health status
The first level of a Medicare appeal in which the carrier is asked to review its initial decision
Premises:
Decision maker at the third level of a Medicare appeal, which includes a hearing
The method of documentation most widely used by physicians for record keeping
The second level of appeal for Medicare claims, during which these entities process reconsiderations of a carrier’s redetermination
The submission of additional clinical and other pertinent information to an insurance carrier to overturn a denied or downcoded claim
An objective, unbiased group of physicians that determines what payment is adequate for services provided
The examination and verification of claims and supporting documents submitted by a physician
The section of the law that governs refunds of overpayments where no contract language exists
The law that protects the interests of beneficiaries enrolled in private employee benefit plans
The chronological recording of pertinent facts and observations about a patient's health status
The first level of a Medicare appeal in which the carrier is asked to review its initial decision
Responses:
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