Understanding Health Insurance: A Guide to Billing and Reimbursement (MindTap Course List)
14th Edition
ISBN: 9781337554220
Author: Michelle A. Green
Publisher: Cengage Learning
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Coordination of benefits (COB) includes:
Reimbursement when a patient is covered by more than 1 health plan
Reimbursement for non-covered services
Reimbursement for not medically necessary services
Reimbursement for diagnosis mismatch
A client asks the nurse about the significance of black box warnings included on
the label of specific prescription medications. What information should the
nurse provide to the client? Select all that apply.
"They advise the nurse about look-alike or sound-alike drugs."
"They advise the client about serious potential risks related to the use of
the drug."
"They advise the healthcare professional about serious side effects related
to the use of the drug."
"They advise the healthcare professional about serious potential risks
related to the use of the drug."
"They advise the nurse about the dosage strength of the drug and the
recommended route of administration."
"They indicate the need to consult the pharmacist, and seek reliable drug
references and U.S. Food and Drug Administration (FDA)
recommendations."
Competency Assessment Information:
Use the following information to complete the Treatment Authorization Request
Scenario: Dr. King has ordered an MRI of the knee for Roberto Benini to confirm a diagnosis of
osteomyelitis. The MRI will be done at Northborough Advanced Imaging. The patient is insured through
Aetna, which requires preauthorization for this procedure
Patient Demographics: Name: Roberto Benini
Phone # (123) 555-1212
Address: 77 Treelawn Place Northborough, XY 12345
DOB: 12/05/1965
Referring Facility: Northborough Advanced Imaging
Phone # (123) 555-8900
Address: 1500 Broadway Boulevard Northborough, XY 12345
Clinic: Dr. Mark King,
NPI 9995020212
Phone # (123) 456-7890
Address: 8600 Main Street, Suite 200, River City, XY 01234
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