Medical claims specialist is to verify the patient

Reference no: EM133704953

Question

Part of your job duties as a Medical Claims Specialist is to verify the patient and insurance information, the assigned codes for services provided, and the dates of service for each claim are correct before they are sent to Medicare for reimbursement. You come across a claim in which you need more information, so you send a query to the physician. You learned that the patient didn't have the procedure listed on the claim, but instead had a less-invasive procedure which wouldn't cost Medicare as much money.

1. Would you report this discrepancy to your direct supervisor? Explain why or why not.

2. Explain why you would or would not change the codes on the claim.

3. Describe what you could do to get the codes corrected for the claim.

Reference no: EM133704953

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