Adult-Gerontology Clinical Nurse Specialist (CNS) Practice Exam

In which scenario would a provider typically submit an interim claim?

1. Once the patient is discharged

2. When additional treatment is not anticipated

3. When prolonged treatment is necessary

4. After assessing total treatment costs

The correct answer is: When prolonged treatment is necessary

An interim claim is typically submitted when prolonged treatment is necessary for a patient. This allows healthcare providers to bill for services provided up to that point in the treatment process, rather than waiting until the completion of all treatment. It helps to facilitate cash flow for the provider and ensures that they are compensated for the ongoing care that the patient is receiving. In scenarios where treatment may extend over a longer period, such as in chronic conditions or intensive rehabilitation, interim claims are particularly useful. Submitting these claims at intervals helps to reduce financial strain on the provider while also maintaining a better system for tracking treatment expenses as they accrue. The other scenarios involve situations where there is either a conclusion to treatment (as in the case of discharge) or a lack of anticipated further treatment, which would not warrant interim billing. Assessing total treatment costs generally occurs after treatment completion as part of a comprehensive billing process, not during ongoing care. Therefore, the submission of an interim claim aligns with the need for continuous treatment and the associated billing for those services.