The Process of Determining If a Procedure or Service Is

question 36

Multiple Choice

The process of determining if a procedure or service is covered by the insurance plan and what the reimbursement is for that procedure is the definition of

• A) eligibility.
• B) precertification.
• C) medical necessity.
• D) capitation.

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Definitions:

Strategic View

An approach to decision-making that takes into account the broader implications and outcomes of actions, often considering the long-term objectives.

First Move

A strategy or action taken by a player or participant before anyone else in a game or competitive scenario.

Commit

A promise or firm decision to do something.

Commission Salesman

A salesperson who earns income based on the percentage of sales they generate.