Denials

Question number 2

Denials occur for various reasons except for?

Medical necessity has been met 

Patient no longer covered under the policy 

Pre-existing condition not covered by the patient’s policy I

nvalid dates of service 

Question number 3

Balances owed by the patient include (select all that apply)

Coinsurance 

Write-off

Copayment

Deductible 

Question number 4

A patient has Medicare and Medicaid, which plan is secondary?

The patient is self-pay 

Medicare 

Medicaid 

Neither plan 

Question number 5

All the following are true in the appeals process EXCEPT:

If the appeal concerns urgent care, the payer must respond within 72 hours of receiving the request.

If the appeal concern is non-urgent care not yet received the payer has 30 days to respond. 

If the appeal concern is for services already received the payer has 60 days to respond.   

If the appeal concerns urgent care, the payer must respond within 24 hours of receiving the request.