A nurse works as a reviewer of Medicare claims. In this capacity, the nurse frequently denies these claims. What is the primary rationale for this action?

Question

Quizplus · Accepted Answer

1. The rationale for reviewing claims for Medicare payment is to be certain that the claims are valid and for necessary procedures. This validation helps to protect the money in the Medicare Trust Fund from being used inappropriately.
2. This is a side benefit from this action, but is not the primary rationale.
3. This is not associated with the review process.
4. Review does not serve to ensure safety of nursing care.

A Nurse Works as a Reviewer of Medicare Claims