Which service is likely to be denied by Medicare for lacking medical necessity?

Prepare for the Certified Specialist Payment Rep Exam with detailed flashcards and multiple-choice questions. Each question includes hints and explanations to help boost your readiness. Master your exam preparation journey now!

The correct choice highlights that routine screenings not aligned with guidelines are often denied by Medicare due to a lack of medical necessity. Medicare has specific coverage guidelines that dictate when screenings are considered medically necessary. If a screening does not meet these established criteria, Medicare will typically deny the claim.

In contrast, services like annual wellness visits, inpatient hospital stays, and emergency room visits usually qualify for coverage under Medicare, as they align with medical necessity based on the patient's current health condition or situation. Annual wellness visits are preventative and encourage ongoing health monitoring, inpatient stays are for acute health issues, and emergency room visits are necessary for urgent medical conditions. Thus, the reason for denial in the case of routine screenings is tied to the adherence to established medical guidelines, which ensures that Medicare funding is allocated appropriately to services genuinely needed for patient care.

Subscribe

Get the latest from Examzify

You can unsubscribe at any time. Read our privacy policy