The Medicare Integrity Program Includes Medical Review, Which Is Defined

question 37

Multiple Choice

The Medicare Integrity Program includes medical review, which is defined by CMS as a review of claims to determine whether services provided are __________, as well as to followup on the effectiveness of previous corrective actions.

• A) affordable by patient populations
• B) covered by the Medicare program
• C) effective for treatment of conditions
• D) medically reasonable and necessary

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Definitions:

Need for Closure

The desire to find an answer or to come to a decision quickly in order to alleviate uncertainty and ambiguity.

Ambiguity

The presence of uncertainty or vagueness in meaning in expressions or situations.

Need for Cognition

A psychological tendency to engage in and enjoy effortful cognitive activities.

Effortful Thinking

The process of engaging in mental activities that require significant cognitive resources, as opposed to automatic or effortless thinking.