NEWEST 2026/2027 ACTUAL EXAM
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Allmofmthemfollowingmaremtruemregardingmcoordinationmofmbenefitsm(COB)mexcept:
mA)mCOBmpreventsmdoublempaymentmformservicesmwhenmamsubscribermhasmhealthminsurancemcover
agemfrommtwomormmoremsources.
m B)mCOBmismvoluntary.
mC)mCOBmdeterminesmwhichminsurermpaysmfirstmwhenmtheminsuredmismcoveredmundermmoremthanmo
nemhealthminsurancempolicy.
mD)mCOBmcoordinatesmworkers'mcompensationmwithmhealthminsurancemcoverage.m-
mCORRECTmANSWERmAnswer:mD)mCOBmcoordinatesmworkers'mcompensationmwithmhealthminsuranc
emcoverage.
Rationale:mCOBmdoesmnotmcoordinatembenefitsmwithmworkersmcompensation.mCOBmismamvoluntarym
programmthatmpreventsmdoublempaymentmformservicesmwhenmthemsubscribermhasmhealthminsuranc
emfrommmoremthanmonemsource.mCOBmhasmrulesmtomdeterminemwhichminsurermpaysmfirst.
Utilizationmmanagementmreviewsmservicesmtomensuremthat:
A)meachmlinemitemmonmamsubmittedmclaimmismanmappropriatemcharge
mB)mtheymaremmedicallymnecessary,mprovidedminmthemmostmappropriatemcaremsetting,mandmatmormab
ovemqualitymstandards.
C)mappropriatemdischargemplanningmismperformed.
, D)mtheymaremorderedmbymamphysician,mprovidedminmthemmostmappropriatemcaremsetting,mandmexcee
dmqualitymstandards.m-
mCORRECTmANSWERmAnswer:mB)mtheymaremmedicallymnecessary,mprovidedminmthemmostmappropria
temcaremsetting,mandmatmormabovemqualitymstandards.
Resource:mCCMCmGlossarymofmTerms
Rationale:mUtilizationmManagement:mReviewmofmservicesmtomensuremthatmtheymaremmedicallymnec
essary,mprovidedminmthemmostmappropriatemcaremsetting,mandmatmormabovemqualitymstandards.
Themcasemmanagersmrolemwhenmworkingmwithmclientsmwithmsubstancemabusemismto:
A)mMotivatemthemclientmtomchange.
B)mSupportmthemtreatmentmplanmandmassistminmfindingmresources.m
C)mCounselmthemclient.
D)mMonitormformsubstancemuse.m-
mCORRECTmANSWERmAnswer:mB)mSupportmthemtreatmentmplanmandmassistminmfindingmresources.
Tommeetmthemcriteriamofmmedicalmnecessitymallmofmthemfollowingmshouldmbempresentmexcept:
A)mItmismreasonable
B)mItmismbasedmonmevidence-basedmstandardsmofmcare
C)mItmismappropriate
D)mItmismcustodialm-mCORRECTmANSWERmAnswer:mD)mItmismcustodial
ThemAmbulatorymPaymentmClassificationmSystemm(APC)mismusedmtomdeterminempaymentmratesmform
whichmonemofmthemfollowingmundermMedicare?
A)mAmbulatorymsurgery
B)mOutpatientmrehabilitationmandmambulatorymsurgery
C)mER,mhospital-basedmclinic,mobservation,mandmambulatorymsurgery