Adult-Gerontology Clinical Nurse Specialist (CNS) Practice Exam

What is not true regarding interim claims?

1. They can only be submitted once

2. They are used for ongoing service requests

3. They are typically submitted for specific billing periods

4. They are not meant for complete episodes of care

The correct answer is: They can only be submitted once

Interim claims are claim submissions for services rendered to patients that take place during a care episode, often in scenarios where continued service is expected or when services have ongoing needs. It is not true that interim claims can only be submitted once. In fact, they can be submitted multiple times throughout the course of treatment, particularly if there are ongoing service requests or changing needs of the patient. This flexibility allows for billing for services as they are provided rather than waiting until a complete episode of care has finished. This is especially useful in settings like long-term care or home health, where patients may require regular services but do not need to have all billing processed at once. The other aspects of interim claims — that they are used for ongoing service requests, typically submitted for specific billing periods, and are not intended for complete episodes of care — accurately reflect their purpose and usage in practice.