Healthcare Payers Base Their Decision to Pay or Deny Claims

question 82

Multiple Choice

Healthcare payers base their decision to pay or deny claims on the:

• A) diagnosis codes only.
• B) procedure codes only.
• C) diagnosis and procedure codes.
• D) neatness of the claim.

Identify the role of emotional and rational appeals in sales messages.

Recognize the importance of choosing the appropriate medium and structure for sales messages.

Acknowledge the ethical considerations in framing sales messages.

Determine how to effectively organize persuasive messages for varied audiences.

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Definitions:

Unique Problem

Refers to a problem that is distinct and different in its characteristics, not fitting typical patterns or previous experiences.

Programmed Decisions

Decisions that are routine and repetitive, for which established rules or procedures can be developed and applied.

Structured Problems

Structured problems are well-defined, clear, and straightforward issues that can be solved through recognized procedures and methods.

Unstructured Problems

Involve situations that are complex and lack clear definition or a straightforward solution path, often requiring creative problem-solving techniques.