Test Bank for Medical Insurance 8th Edition By Valerius-25 PDF

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49) Which term best describes medical services that meet professional medical standards? A) medical etiquette. B) medical networks. C) medical necessity. D) medical ethics. Answer: C Explanation: For more information, the definition of medical necessity can be located in the Medicare.gov glossary. It is a payment concept--payers do not pay for medically unnecessary procedures and treatments. Difficulty: 1 Easy Topic: Health Maintenance Organizations Learning Objective: 01.04 Bloom's: Remember ABHES: 7.d Graduates will be able to: Process insurance claims CAHIIM: IV.A.1 Apply policies and procedures for the use of data required in healthcare reimbursement 50) Which of the following is required when an HMO patient is admitted to the hospital for nonemergency treatment? A) referral B) coinsurance C) preauthorization D) utilization Answer: C Explanation: Patients must secure preauthorization for nonemergency hospitalizations. Difficulty: 2 Medium Topic: Health Maintenance Organizations Learning Objective: 01.04 Bloom's: Understand ABHES: 7.d Graduates will be able to: Process insurance claims CAHIIM: IV.A.1 Apply policies and procedures for the use of data required in healthcare reimbursement

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