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:

Discount

A reduction from the usual cost of something, typically given for prompt or advance payment or to a special category of buyers.

Principal

A principal can refer to the main party involved in a financial transaction or the original amount of a debt or investment before interest.

Wrongful Acts

Actions or behaviors that are illegal or immoral, leading to harm or injury against another person or entity.

Agent

An individual or entity authorized to act on behalf of another (the principal) in dealings with third parties.