Question

Services and/or supplies used to treat the patient's diagnosis meet the accepted standard of medical practice is the definition of:

a. precertification.
b. capitation.
c. eligibility.
d. medical necessity.

Answer 1

The definition of services and/or supplies that are used to treat the patient's diagnosis and meet the accepted standard of medical practice is known as 'medical necessity.' This is distinct from precertification, capitation, and eligibility, which are related to healthcare payment arrangements and insurance coverage.

Step-by-step explanation:

Medical necessity is defined as services and/or supplies that are used to treat the patient's diagnosis and meet the accepted standard of medical practice. The correct answer to your question is 'd. medical necessity.' This concept is crucial in the healthcare industry to ensure that the treatments provided are necessary for the health and recovery of the patient, align with the standards of medical care, and are not excessive or unnecessary.

Precertification, capitation, and eligibility are distinctly different from medical necessity. Precertification is a pre-approval process by an insurance provider for medical services. Capitation is a payment arrangement for healthcare service providers, where they are paid a set amount per patient regardless of the number of services provided. Eligibility refers to whether a patient qualifies for a particular healthcare program or insurance coverage. Understanding the term medical necessity is essential in healthcare billing and insurance claims.