Claims Adjudication Involves Making a Determination About __________ Charges, Which

question 21

Multiple Choice

Claims adjudication involves making a determination about __________ charges, which is the maximum amount the payer will permit for each procedure or service, according to the patient's policy.

• A) allowed
• B) denied
• C) inconsistent
• D) irregular

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Definitions:

U.S. Antitrust Laws

Laws enacted by the U.S. to protect consumers from predatory business practices by ensuring that fair competition exists in an open-market economy.

Federal Trade Commission Act

A U.S. federal law established in 1914 to promote consumer protection and eliminate and prevent anticompetitive business practices.

Anticompetitive Behavior

Actions by businesses aimed at undermining competition, often through unfair practices, to maintain or acquire market dominance.

Antitrust Law

A body of laws designed to prevent anti-competitive practices, monopolies, and to promote fair competition for the benefit of consumers.