CPB (Certified Professional Biller) Certification Practice Exam

Who submits written confirmation authorizing treatment to a provider in a healthcare setting?

1. Category II Codes

2. Category I Codes

3. Case Manager

4. Catastrophic Cap Benefit

The correct answer is: Case Manager

The correct answer pertains to the role of the case manager in a healthcare setting. A case manager is responsible for coordinating patient care and may need to submit written confirmation authorizing treatment to ensure that necessary procedures are approved and covered by insurance. This role involves evaluating and ensuring that the treatment aligns with the patient's needs and the healthcare provider's capabilities. Category I and Category II codes refer to the Current Procedural Terminology (CPT) codes used for billing purposes and do not relate to the authorization of treatment. The focus of these codes is on classification and reimbursement rather than on the administrative process of approving treatment. The term "Catastrophic Cap Benefit" refers to a specific insurance feature that limits out-of-pocket expenses after reaching a certain threshold, and it does not pertain to who authorizes treatment within the healthcare system. Thus, the case manager's role is crucial for facilitating the authorization process and ensuring comprehensive patient care.