For Certain Items or Services Reported on a Claim Submitted

question 39

Multiple Choice

For certain items or services reported on a claim submitted to the DME MAC, the DMEPOS dealer must receive a signed certificate of medical necessity from the __________ before submitting a claim to Medicare.

• A) administrative contractor
• B) patient or guarantor
• C) third-party payer
• D) treating physician

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Definitions:

Ethical Standards

The principles that govern the behavior of individuals and organizations, ensuring actions are moral and right.

Peers

Individuals of similar status or within the same social group, often used to describe professional counterparts or classmates.

Unethical Practices

Actions or behaviors that violate moral or professional guidelines meant to maintain fairness, integrity, or respect for the rights and welfare of others.

Managers

Individuals in an organization responsible for planning, leading, organizing, and controlling resources to achieve specific goals.