Demonstrate justification for an EOB claim related to medical necessity

These Case Studies are created to test the student’s ability to reference previous knowledge or resources to find solutions to the cases by using critical thinking.  Students may have to do additional research to find the materials they need to correctly answer the cases if they do not recall them from previous courses.  The cases resemble ‘real-life scenarios” that graduates may encounter.

All of these cases resemble common situations that HIM professionals may address.  Even when it is not in “their job description”, because you are in HIM, it may be assigned to you to resolve.  As you work through these assignments, think about the big picture of HIM and how it relates to compliance, billing, and reporting of procedures and treatments.

Complete the following cases:

Case 5-13 (page 229) Documentation Improvement (25 points)

Upon completion of this assignment, students should be able to meet the following module learning objective:

MLO 23: Identify clinical documentation improvement practices

Case 4-5 (page 174) Explanation of Benefits (EOB) (25 points)

Upon completion of this assignment, students should be able to meet the following module learning objective:

MLO 23: Demonstrate justification for an EOB claim related to medical necessity

Case 5-17  Medical Necessity  (25 points)

  • Upon completion of this assignment, students should be able to meet the following module learning objective:

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