Review for medical necessity of tests/procedures ordered during inpatient hospitalization.
Elisia GarzaOST 136January 25, 2017Questions for ReviewSELECT THE BEST ANSWER1.The intent of managed health care was to Show
Get answer to your question and much more 2.Which term best describes those who receive managed health care plan services? Get answer to your question and much more 3.The Medical Center received a $100,000 capitation payment in January to cover thehealth care costs of 150 managed care enrollees. By the following January, $80,000 hadbeen expended to cover services provided. The remaining $20,000 is Get answer to your question and much more 4.A nonprofit organization that contracts with and acquires the clinical and business assetsof physician practices is called a Get answer to your question and much more 5.A __ is responsible for supervising and coordinating health care services for enrollees. Get answer to your question and much more 6.The term that describes requirements created by accreditation organizations is Get answer to your question and much more 7.Arranging appropriate healthcare services for discharged patients. Get answer to your question and much more 8.Review for medical necessity of inpatient care prior to admission. Cigna defines Medical Necessity in the following four ways:
Full descriptions of each are given below. Cigna's Definition of Medical Necessity for Physicians"Medically Necessary" or "Medical Necessity" means health care services that a physician, exercising prudent clinical judgment, would provide to a patient. The service must be:
For these purposes, "generally accepted standards of medical practice" means:
Preventive care may be Medically Necessary, but coverage for Medically Necessary preventive care is governed by terms of the applicable Plan Documents. Cigna's Seniors Definition of Medical Necessity for other Health Care ProvidersExcept where state law or regulation requires a different definition, "Medically Necessary" or "Medical Necessity" refers to health care services that a health care provider, exercising prudent clinical judgment, would provide to a patient. The service must be:
For these purposes, "generally accepted standards of medical practice" means:
Preventive care may be Medically Necessary, but coverage for Medically Necessary preventive care is governed by terms of the applicable Plan Documents. Cigna's Seniors Definition of Medical Necessity for PhysiciansExcept where state law or regulation requires a different definition, "Medically Necessary" or "Medical Necessity" refers to health care services that a health care provider, exercising prudent clinical judgment, would provide to a patient. The service must be:
For these purposes, "generally accepted standards of medical practice" means:
Preventive care may be Medically Necessary but coverage for Medically Necessary preventive care is governed by terms of the applicable Plan Documents. Cigna's Seniors Definition of Medical Necessity for other Health Care ProvidersExcept where state law or regulation requires a different definition, "Medically Necessary" or "Medical Necessity" shall mean health care services that a health care provider, exercising prudent clinical judgment, would provide to a patient. The service must be:
For these purposes, "generally accepted standards of medical practice" means:
Preventive care may be Medically Necessary but coverage for Medically Necessary preventive care is governed by terms of the applicable Plan Documents. Medical Necessity Criteria for Treatment of Mental Health and Substance Use DisordersCigna believes that all treatment decisions that are made in alignment with the Medical Necessity Criteria must be first and foremost clinically based. Care must be patient-centered and take into account the individuals’ needs, clinical and environmental factors, and personal values. Learn more about our Behavioral Health Guidelines. Which is a review for medical necessity of tests and procedures?Health Insurance Claims Chapter 3. Which of these is a review of the appropriateness and necessity of care provided to patients prior to the administration of care?The utilization management (or utilization review) is a method of controlling healthcare providers and quality of care by reviewing the appropriateness and necessity of care provided to patients prior to the administration of care.
Which type of claim includes those that were rejected due to an error?Health Ins. Chapter 4. Which of these is supporting documentation or information associated with a health care claim or patient encounter?study guide. |