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:

Overhead Costs

Indirect expenses related to the operation of a business that are not directly assignable to a specific product or service.

Direct Labor Hours

The total hours worked by employees directly involved in the manufacturing of a product or the provision of a service.

Machine Hours

A measure of production time used in cost accounting to allocate costs to products or job orders, based on the hours a machine is operated.

Batch Size

The quantity of items or units produced in a single manufacturing run or production cycle, which can significantly impact production efficiency and cost.