List the types of businesses that employ health insurance specialists, and discuss the job functions of these specialists
Health insurance specialists are employed by insurance companies, third-party administrators, and managed-care companies. A health insurance specialist (or claims examiner) reviews health-related claims to determine whether the costs are reasonable and medically necessary given patient's diagnosis, and will also verify claims against third-party payer guidelines to authorize payment.
You might also like to view...
Which of the following actions is NOT permitted by an advance directive?
A) Providing only comfort measures, such as pain medication B) Withholding CPR if cardiac arrest is not witnessed C) Refusing to allow long-term life support measures, such as a ventilator or feeding tube D) Assisting with a suicide via a medication overdose
In which of the following situations would you recommend that more than one ventilator be pro-vided for a home care patient?
1. If the patient cannot maintain spontaneous ventilation for at least 1 hr 2. If the patient's care plan requires mechanical ventilation during mobility 3. If a replacement ventilator cannot be secured within 2 hr a. 1 and 2 only b. 2 and 3 only c. 1 and 3 only d. 1, 2, and 3
A pay schedule
A. indicates whether an employee is paid hourly, salaried, or on commission. B. outlines the number of dependents. C. refers to the total amount of income earned before deductions. D. determines the type of voluntary deductions taken.
Which of the following is the main reason for dusting shelves and furniture in the examination room?
A. It gives a clean appearance. B. It is an efficient way to pass the time between patient appointments. C. It eliminates dust that harbors bacteria and allergens. D. It preserves the finish of the furniture. E. It promotes a sterile environment.