Learning Outcomes
After studying this chapter, you should be able to:
Describe the steps payers follow to adjudicate claims. |
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List ten checks that automated medical edits perform. |
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Describe the procedures for following up on claims after they are sent to payers. |
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Identify the types of codes and other information contained on an RA/EOB. |
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List the points that are reviewed on an RA/EOB. |
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Explain the process for posting payments and managing denials. |
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Describe the purpose and general steps of the appeal process. |
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Discuss how appeals, postpayment audits, and overpayments may affect claim payments. |
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Describe the procedures for filing secondary claims. |
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Discuss procedures for complying with the Medicare Secondary Payer (MSP) program. |