Adult-Gerontology Clinical Nurse Specialist (CNS) Practice Exam

Identifying which claims should be submitted as interim requires a nurse to have knowledge of?

1. Patient authentication protocols

2. Regulatory requirements

3. Clinical documentation practices

4. Billing and coding guidelines

The correct answer is: Billing and coding guidelines

Understanding which claims should be submitted as interim relies heavily on knowledge of billing and coding guidelines. This knowledge is crucial because interim claims are typically used in specific situations where a patient's services extend over a lengthy period, such as in rehabilitation or long-term care settings. Properly identifying the timing and appropriateness of submitting these claims often depends on understanding how services rendered translate into billable units and how coding requirements align with the payer's policies. Billing and coding guidelines dictate how and when to bill for services, including the criteria that must be met for interim claims to be accepted. This information can affect reimbursement timelines and help avoid claim denials or delays. Overall, the ability to interpret and apply these guidelines ensures that the financial aspects of patient care are adequately managed, facilitating continuous care without unnecessary interruptions in funding.