Answered

A medical assistant receives a denial of payment for a patient's cholecystectomy. The reason stated is "preauthorization required." If the provider
deems this procedure emergent, which of the following actions should the assistant take?
Submit an appeal for the denied claim.
Submit a new claim.
Resubmit the claim with a different procedure code.
Instruct the patient to contact the insurer about the denial of payment.



Answer :

GinnyAnswer

Final answer:

In the case of a denied claim for an emergent cholecystectomy, the medical assistant should appeal, submit a new claim, and instruct the patient to contact the insurer.


Explanation:

Submit an appeal for the denied claim. If the provider deems the cholecystectomy emergent, the medical assistant should appeal the denial. Appeals provide a formal process to challenge the denial based on medical necessity, including submitting any supporting documentation.

Submit a new claim. In addition to appealing, submitting a new claim with proper documentation supporting the emergent nature of the procedure can help secure payment for the cholecystectomy.

Instruct the patient to contact the insurer about the denial of payment. The patient may need to communicate with the insurer to provide additional details or authorize the release of medical information to support the emergent nature of the procedure.


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