National Center for Competency Testing (NCCT) Medical Assistant Practice Test

Determining whether a specific medical treatment will be covered under a patient's insurance involves what process?

1. Authorization

2. Pre-certification

3. Claim submission

4. Co-payment

The correct answer is: Pre-certification

The process of determining whether a specific medical treatment will be covered under a patient's insurance is known as pre-certification. This involves obtaining approval from the insurance company before the treatment is rendered to ensure that it is medically necessary and will be covered under the patient's insurance plan. This step is crucial, as it helps to confirm coverage, potentially avoiding unexpected expenses for the patient. Pre-certification typically requires the healthcare provider to provide detailed information about the patient's condition, the proposed treatment, and the expected outcomes. Once the insurance company reviews this information, they can provide the provider with a decision regarding coverage. In contrast, authorization also refers to obtaining permission for specific services but is often used in conjunction with different interventions that may not directly address the initial determination of coverage. Claim submission occurs after services have been provided and is more about billing and obtaining payment rather than pre-emptively determining coverage. A co-payment is a fixed amount that a patient pays at the time of service for covered healthcare services, but it does not relate to the process of confirming if a treatment is covered at all.