Exam 16: Refunds and Appeals

A provider has 120 days to file a request with the Medicare carrier for a redetermination on a denied claim.

When appealing disallowances resulting from low maximum allowable fees, the medical office assistant should include information:

Using the SOAP format, documentation of the physical examination performed by the physician is:

Match the following -The chronological recording of pertinent facts and observations about a patient's health status

In general, Medicaid can request refunds for overpayments to providers for up to:

Under ERISA, a carrier must respond to a claim that has been filed within 120 days.

Using the SOAP format, the evaluation and management (E/M) history that the physician takes is:

Qualified independent contractors must process a reconsideration within:

When a carrier denies a claim because it determines that another carrier should be the primary payer, ________ of benefits is needed to determine the responsibility of each payer.

Providing additional clinical information to an insurance company as part of an attempt to overturn a claim denial is known as submitting a(n):

Where can a medical office specialist find sample appeal letters?

What is SOAP?

Reasons to rebill an insurance claim include all of the following EXCEPT:

Physicians must file a Medicare appeal with an administrative law judge within:

Statistics show that the percentage of claims typically overturned on the first appeal is:

Physicians essentially have 6 months to file a second-level appeal.

Using the SOAP format, medication ordered for the patient is:

The law that protects the interests of beneficiaries enrolled in private employee benefit plans is known as:

Match the following -The section of the law that governs refunds of overpayments where no contract language exists

Many medical associations now have a complaint review process and will assist you with resolving denied insurance claims.