A medical assistant is submitting an urgent referral request to an insurance company for authorization. Which of the following describes how long the authorize process will take?
24 hr
3 working days
Immediate approval via phone
10 days
The Correct Answer is C
A. 24 hr: Urgent referrals often require quick processing, but it may take longer than 24 hours depending on the insurance company's policies.
B. 3 working days: This time frame is more typical for standard, non-urgent referrals.
C. Immediate approval via phone: Urgent referrals can sometimes be approved immediately via phone, particularly when immediate care is needed. This is the most appropriate choice for an urgent situation.
D. 10 days: Ten days is too long for an urgent referral and is more typical for non-urgent or routine requests.
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Correct Answer is D
Explanation
A. The patient reports the receptionist was rude to them. This is not relevant to the patient’s medical care and should not be documented in the health record.
B. The patient states that there is an error on their bill. Billing issues are not related to the clinical care of the patient and should not be documented in the health record.
C. The patient states their insurance might be changing soon. This is administrative information and does not pertain to the clinical aspect of the patient’s care.
D. The patient reports they recently developed a strawberry allergy. This is relevant medical information that could affect the patient’s treatment and should be documented in the health record.
Correct Answer is C
Explanation
A. Bone density test: Bone density tests are typically recommended for women starting around age 65 or earlier if risk factors are present, but they are not usually performed annually.
B. Dilated eye exam: While dilated eye exams are important, they are generally recommended every 1-2 years, not annually, unless specific conditions warrant more frequent exams.
C. Papanicolaou (Pap) test: The Pap test is recommended every 3 years for women aged 21-65 or every 5 years with HPV testing for those aged 30-65. Annual documentation is not required, but it is important to monitor this screening as part of preventative care.
D. Mammogram: Mammograms are typically recommended every 1-2 years for women starting at age 40, not annually.