Question

Medicare Part B claims are adjudicated in a/an __________ manner.

A) Real-time
B) Appropriate
C) Timely
D) Non-real-time

Answer 1

Medicare Part B claims are adjudicated in a non-real-time manner, allowing for thorough review and preventing fraudulent claims.

Step-by-step explanation:

The correct answer is D) Non-real-time.

Medicare Part B claims are adjudicated in a non-real-time manner, which means that they are processed offline rather than in real-time. This allows for a more thorough review of the claims to ensure accuracy and appropriateness before payment is made.

For example, Medicare Part B claims may go through a review process where a claims examiner carefully evaluates the claim, checks for documentation, and verifies medical necessity. This non-real-time adjudication process helps prevent fraudulent claims and ensures that Medicare is only paying for eligible services.

Answer 2

Medicare Part B claims are adjudicated in a non-real-time manner, which involves a processing delay, but they must still be completed in a timely fashion (option D).

Step-by-step explanation:

Medicare Part B Claim Adjudication

Medicare Part B claims are adjudicated in a non-real-time manner. Adjudication refers to the process by which Medicare reviews a claim to determine whether the service is covered and how much they will reimburse for that service. Unlike real-time adjudication which occurs instantly, non-real-time adjudication involves a delay as claims are collected, processed, and then the payment decision is relayed back to the healthcare provider. It's important to note that even though adjudication is not done in real-time, Medicare Part B claims must still be processed in a timely manner as per Medicare guidelines, ensuring beneficiaries and providers do not face unnecessary delays.

Hence, the answer is option D.