Adult-Gerontology Clinical Nurse Specialist (CNS) Practice Exam

When would a healthcare provider most likely submit an interim claim?

1. At the onset of treatment

2. When a patient’s treatment is ongoing

3. At the point of discharge

4. After a follow-up appointment

The correct answer is: When a patient’s treatment is ongoing

An interim claim is typically submitted during an ongoing treatment process when a provider wants to request payment for services rendered at that point in time, rather than waiting until the entire treatment course is complete. This approach helps manage cash flow for healthcare providers, especially in cases where treatment extends over a lengthy period or involves multiple sessions. Submitting an interim claim allows the provider to receive reimbursement for the services already provided, ensuring that the financial aspects of the patient's care are adequately managed. In contrast, submitting a claim at the onset of treatment may not be standard practice because claims are often filed after services have been delivered. Submitting at the point of discharge is generally associated with a final claim, which includes all services provided throughout the patient's care. Similarly, submitting a claim after a follow-up appointment might not align with the typical process for ongoing treatments, particularly if the follow-up is part of the larger treatment plan. Thus, ongoing treatment is the most logical time for an interim claim.