A Claims Examiner Employed by a Third-Party Payer Reviews Health-Related

question 22

Multiple Choice

A claims examiner employed by a third-party payer reviews health-related claims to determine whether the charges are reasonable, in addition to

• A) assigning ICD-10-CM and CPT codes.
• B) billing patients for copayments and coinsurance.
• C) determining medical necessity of services/procedures.
• D) resubmitting denied claims to health care providers.

Identify decision-making methods suitable for various scenarios based on Vroom's model.

Analyze the role of goal clarity and optimism in group success.

Learn how to prevent groupthink in decision-making.

Understand and apply concepts of cross-cueing and transactive memory systems in group settings.

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Definitions:

Corporate Governance

The system of rules, practices, and processes by which a company is directed and controlled, involving balancing the interests of its stakeholders.

Strategy Implementation

The execution of a strategic plan or the process of putting a newly chosen strategy into effect to achieve organizational goals.

Focused Cost Leadership

A strategy where a business aims to be the lowest cost producer in a specific niche or segment.

Competitive Advantage

The attributes that allow an organization to outperform its competitors, including cost structure, product offerings, brand reputation, and customer service.