CCM EXAM 2024 /2025 WITH 100% ACCURATE SOLUTIONS

  CCM EXAM 2024 /2025 WITH 100% ACCURATE SOLUTIONS All of the following are true regarding coordination of benefits (COB) except: A) COB prevents double payment for services when a subscriber has health insurance coverage from two or more sources. B) COB is voluntary. C) COB determines which insurer pays first when the insured is covered under more than one health insurance policy. D) COB coordinates workers' compensation with health insurance coverage. - Precise Answer Answer: D) COB coordinates workers' compensation with health insurance coverage. Rationale: COB does not coordinate benefits with workers compensation. COB is a voluntary program that prevents double payment for services when the subscriber has health insurance from more than one source. COB has rules to determine which insurer pays first. Utilization management reviews services to ensure that: A) each line item on a submitted claim is an appropriate charge B) they are medically necessary, provided in the most appropriate care setting, and at or above quality standards. C) appropriate discharge planning is performed. D) they are ordered by a physician, provided in the most appropriate care setting, and exceed quality standards. - Precise Answer Answer: B) they are medically necessary, provided in the most appropriate care setting, and at or above quality standards. Resource: CCMC Glossary of Terms Rationale: Utilization Management: Review of services to ensure that they are medically necessary, provided in the most appropriate care