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ISC2 HCISPP Exam - Topic 6 Question 32 Discussion

They examine cost of claims to determine whether it is a reasonable or necessary, according to diagnosis.
C) Health Insurance Specialist
A) Coders
B) Billers

ISC2 HCISPP Exam - Topic 6 Question 32 Discussion

Actual exam question for ISC2's HCISPP exam
Question #: 32
Topic #: 6
[All HCISPP Questions]

They examine cost of claims to determine whether it is a reasonable or necessary, according to diagnosis.

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Suggested Answer: C

by Claribel at May 08, 2022, 02:03 PM

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Paz
8 months ago
I thought it was all about the diagnosis, not just costs.
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Dottie
9 months ago
Wait, are billers really the ones doing this? Seems off.
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Shonda
9 months ago
Coders mainly focus on coding, not claims.
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Glynda
9 months ago
Totally agree, they know the ins and outs of claims.
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Haydee
9 months ago
Sounds like a job for health insurance specialists!
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Tanesha
9 months ago
I feel like I've seen similar questions, and it could go either way between coders and health insurance specialists, but I lean towards the latter.
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Lucina
9 months ago
This sounds like something a health insurance specialist would do, especially when determining if a claim is justified.
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Ellsworth
9 months ago
I remember a practice question about the role of billers in reviewing claims, but I can't recall if they specifically look at the cost versus diagnosis.
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Lisbeth
9 months ago
I think this might relate to how coders assess the appropriateness of claims based on the diagnosis codes, but I'm not entirely sure.
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Magda
9 months ago
Okay, I know RDDs can be generated from Hadoop file systems, but the partial update part is throwing me off. Let me re-read the question.
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Carma
10 months ago
No problem, I've got a good handle on this type of question. I'll methodically work through the details, identify the key information, and arrive at the correct true/false answer. Bring it on!
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