If a Carrier Downcodes a Claim and the Provider Maintains

question 56

Multiple Choice

If a carrier downcodes a claim and the provider maintains that the reported services were medically necessary, the medical office specialist should:

• A) send a bill to the patient for the remaining balance.
• B) write off the remaining balance.
• C) file an appeal with the insurance carrier.
• D) send a complaint to the state insurance commissioner.

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Definitions:

Rational Understandings

The ability to comprehend, interpret, and reason about information or situations in a logical and coherent manner.

Naïve Optimism

An overly positive and simple belief in the most favorable outcome of any situation without considering the complexities or potential challenges.

Tangible Benefits

Concrete advantages or gains, such as profit or improved health, which are directly attributable to a specific action or policy.

Technological Innovations

New inventions and improvements in existing technologies that can potentially change people's lives and society's structures.