A Health Insurance Specialist Reviews Health-Related Claims to Determine Whether

question 19

Short Answer

A health insurance specialist reviews health-related claims to determine whether the costs are reasonable and medically necessary given the patient's diagnosis. This position is also called a ____________________.

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Definitions:

American Bar Association (ABA)

The largest voluntary association of lawyers and law students in the United States, which sets academic and ethical standards for the legal profession.

Contingency-Fee Basis

A payment structure where a lawyer receives a percentage of the client's settlement or judgment as a fee, only if the case is won.

Double Billing

The unethical practice of charging more than once for the same service or work, often found in legal and medical billing.

Billable Time

The time that professionals, like lawyers or consultants, record for tasks they perform on behalf of their clients, which determines how much the client will be charged.