Adult-Gerontology Clinical Nurse Specialist (CNS) Practice Exam

What is the consequence of submitting a claim for a patient who has already been discharged?

1. It is processed without issue

2. It may cause delays in payment

3. It is automatically approved

4. It is deemed non-compliant

The correct answer is: It is deemed non-compliant

Submitting a claim for a patient who has already been discharged can lead to non-compliance issues as it may not adhere to the necessary protocols for billing and reimbursement. When a patient is discharged, specific timelines and guidelines dictate how claims must be submitted. If a claim is submitted after the discharge without aligning with these regulations, it can be seen as not conforming to the established billing practices, resulting in non-compliance. This can hinder the facility's ability to receive timely payments and create administrative complications that could lead to further audits or oversight. Compliance with billing standards is crucial in maintaining the integrity of the healthcare reimbursement process.