Question

instructions: select the most appropriate response.
which is the process of determining whether services provided are medically reasonable and necessary as defined by cms?
a. case management
b. claims adjudication
c. medical review
d. authorization

Explanation:

Medical review is the process that determines if services are medically reasonable and necessary as per CMS (Centers for Medicare & Medicaid Services) guidelines. Case management focuses on coordinating care, claims adjudication is about deciding claim payments, and authorization is about pre - approval.

Answer:

C. medical review