If a Claim Is Denied Due to Lack of Medical

question 83

True/False

If a claim is denied due to lack of medical necessity, the provider must refund any payment made by the carrier and can bill the patient for the balance.

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Definitions:

Ranges of Scores

Numerical intervals that indicate the variation within which a set of data points fall, often used in statistical analysis to describe the distribution of variables.

Subjective Systems

Tools or methods that rely on personal feelings, tastes, or opinions for assessment or decision-making.

Continuum Models

Theoretical models that describe certain properties or behaviors as occurring on a continuous scale, rather than being divided into distinct categories.

Structured Interview

Meeting between a clinician and a client or a client’s associate(s) in which the clinician asks questions that are standardized and are usually designed to determine whether a diagnosis is warranted.