Match the following:

Question

A) qualified independent contractors (QICs)
B) documentation
C) subjective, objective, assessment, plan (SOAP)
D) administrative law judge (ALJ)
E) ERISA
F) audit
G) peer review
H) Civil Practice and Remedies Code
I) appeal
J) redetermination

1) The examination and verification of claims and supporting documents submitted by a physician

2) The chronological recording of pertinent facts and observations about a patient's health status

3) An objective, unbiased group of physicians that determines what payment is adequate for services provided

4) The submission of additional clinical and other pertinent information to an insurance carrier to overturn a denied or downcoded claim

5) The method of documentation most widely used by physicians for record keeping

6) The law that protects the interests of beneficiaries enrolled in private employee benefit plans

7) The second level of appeal for Medicare claims, during which these entities process reconsiderations of a carrier's redetermination

8) Decision maker at the third level of a Medicare appeal, which includes a hearing

9) The first level of a Medicare appeal in which the carrier is asked to review its initial decision
10) The section of the law that governs refunds of overpayments where no contract language exists

Answer 1

1) F 2) B 3) G 4) I 5) C 6) E 7) A 8) D 9) J 10) H