Free AAMA Certified Medical Assistant (CMA) Practice Question

A claim has been rejected on the basis that the provided medical service appears excessive for the patient's condition. What is the most efficient method a medical office should use to address this type of rejection?

  • Transfer the balance directly to the patient without appealing the insurance company's decision.

  • Resubmit the claim immediately with the same codes in the hope that the claim will not be flagged the second time.

  • Send a generic appeal without including additional justifying documentation or detailed explanation.

  • Appeal the rejection with a letter of medical necessity and any pertinent documentation that supports the service being medically necessary for the patient's condition.

This question's topic:
AAMA Certified Medical Assistant (CMA) / 
Administrative
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