Answer the following statements true (T) or false (F)

1. Medicare can deny or downcode an E/M service if it feels that the service provided exceeds the patient's documented needs.
2. If a medical office specialist does NOT agree with the payment determination made by an insurance company, the decision can be appealed.
3. An audit tool utilizes number counts in different categories to determine if the correct E/M code was used in billing an insurance carrier.
4. An internal audit will NOT be able to help a practice discover lost revenue.
5. The extent of information that the physician gathers for a medical history is based on rules set up by Medicare.


1. TRUE
2. TRUE
3. TRUE
4. FALSE
5. FALSE

Health Professions

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