Identify the differences between government agencies and health insurance carriers. Include the pros and cons of each.
What will be an ideal response?
Government agencies are required to follow CMS guidelines at all times.
Private carriers use CMS as a guide but are entitled to follow or create their own guidelines.
PROS: Following CMS allows everyone’s guidelines to be uniform.
CONS: If private payers can divert, it is difficult to know what everyone wants, due to the large number of carriers available.
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