Page 71 - ractice Exam Questions and rationales

D. Standard.

Your response:
Certified.
Correct response:
Certified.
Rationale: The letter to the patient should be sent Certified so that the physician can see when
the patient receives the letter. With Certified mail, the patient must sign for the letter when
he/she receives it. This ensures that it was delivered to the correct person. Since the patient has
diabetes, it is important for him/her to see a physician regularly to prevent the disease from
getting worse. If a letter is sent Priority it will ship faster than general or first-class mail but
would not be the best choice because the medical assistant needs to make sure that the patient
received the letter about his/her upcoming appointment. Express mail is an international service
that allows people to send mail from country to country and would not be needed in this case
because the patient and physician are in the same country. Standard mail is not sent first-class
and items typically sent by standard mail are newspapers, flyers, and magazines. This also would
not be the best choice because the medical assistant would not have confirmation that the patient
received the letter.
The patient is referred to a neurosurgeon. Entering the specialist’s NPI number and number of
visits requested into the patient’s insurance carrier’s website is part of which of the following
processes?

A. precertification

B. compensation

C. electronic claims submission

D. assignment of benefits

Your response:
precertification
Correct response:
precertification
Rationale: This is an example of the precertification process, which facilitates prior authorization
to confirm eligibility for treatment. Precertification is a process to establish medical necessity
before a treatment is approved. Once precertified, the patient can then see the neurosurgeon. The
patient will sign an assignment of benefits form to allow insurance to directly pay the medical
provider. Then a claim will be submitted (most likely electronically) and insurance will pay the
claim. Some companies offer worker compensation benefits for employees who are injured on
the job.
Which of the following diseases is a healthcare worker at the greatest risk of developing
following an exposure incident with blood from a needle stick injury?