Answer the following statements true (T) or false (F)
1. An explanation of benefits (EOB) is notification the provider sends to the patient detailing what the insurance carrier has paid.
2. the Medicare conversion factor to be used for physician payments as of January 1, 2015, is $35.8043.
3. A claim that is manually reviewed by an insurance carrier can be denied for lack of required preauthorization.
4. f a claim is denied due to lack of medical necessity, the provider must refund any payment made by the carrier and can bill the patient for the balance.
5. Physicians have the right to establish their fees at a level that they believe fairly reflects the costs of providing a service.
1. FALSE
2. TRUE
3. TRUE
4. ALSE
5. TRUE
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You recommend that the staff routinely check to verify that a summary on each patient is
provided to the attending physician so that he or she can review, update, and recertify the patient as appropriate. The time frame for requiring this summary is at least every A. week. C. 60 days. B. month. D. 90 days.