Crucial Exams

AAMA CMA Practice Question

A patient's claim for a complex surgical procedure was denied by their insurance company. The denial stated that the procedure was 'not medically necessary'. Upon review, you discover that the patient's records clearly document the medical necessity of the procedure. What is the most appropriate next step to address this claim denial?

  • File an appeal with detailed supporting documentation and a letter from the physician explaining the medical necessity of the procedure.

  • Adjust the patient's bill to exclude the surgical procedure and proceed with collecting the remaining balance.

  • Resubmit the same claim with an attached note stating the procedure was medically necessary.

  • Immediately direct the patient to pay for the procedure out-of-pocket since the insurance denied the claim.

AAMA CMA
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