If an Insurance Carrier Does NOT Reconsider a Downcoded Claim

question 19

Multiple Choice

If an insurance carrier does NOT reconsider a downcoded claim that has been appealed, the medical office specialist can:

• A) request assistance from the state insurance commissioner.
• B) file a complaint with the Department of Health and Human Services (DHHS).
• C) file a complaint with the Centers for Medicare and Medicaid Services (CMS).
• D) bill the patient for the remaining balance.

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Definitions:

Arterial System

The network of arteries within the body that carries oxygenated blood away from the heart to various tissues and organs.

High-Pressure System

A meteorological term indicating an area of high atmospheric pressure, typically associated with calm, dry weather.

Large-Diameter Vessels

Blood vessels with a relatively wide diameter, such as arteries and veins, important for the circulation of blood.

Arterial Insufficiency

A condition where there is inadequate blood flow through the arteries, often leading to pain and tissue damage.