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Home  arrow Chapter Review Questions  arrow Chapter 15: Workers' Compensation

Chapter 15: Workers' Compensation

This activity contains 16 questions.

Question 1.
Some appeals may be conducted over the telephone, whereas others may require a written appeal.

End of Question 1

Question 2.
If a payer has rejected all of the appeals on a claim, the claimant may take the case to the state's insurance commissioner.

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Question 3.
The Medicare program provides four levels of appeals.

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Question 4.
The SOAP format is used when calling insurance companies to verify benefits.

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Question 5.
When a third-party payer issues a refund request in writing, the practice should issue a refund within 24 hours.

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Question 6.
ERISA stands for Employee Retirement Income Security Act (of 1974).

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Question 7.
Each state's insurance commissioner is the regulatory agency for the insurance industry and serves as a liaison between the patient and the provider.

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Question 8.
Regardless of the method of reimbursement, insurance claims must be monitored until payments are received.

End of Question 8

Question 9.
The governmental department you should go to if multiple appeals to an MCO fail is:

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Question 10.
What percentage of denied claims are overturned on the first appeal?

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Question 11.
If your first appeal is denied, it is appropriate to:

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Question 12.
It is best to direct initial appeal letters to:

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Question 13.
The method of documentation most widely used by physicians is the:

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Question 14.
What percentage of denied claims are overturned on the second appeal?

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Question 15.
Appealing denied insurance claims requires:

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Question 16.
Medicare Part B states the number one reason an appeal is returned is because:

End of Question 16

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