American Health Information Management Association (AHIMA) Certification Practice Exam

Which of the following is NOT necessary for securing payment from the insurer during patient documentation?

1. The reason for the encounter and patient history.

2. A patient assessment, clinical impression, or diagnosis.

3. A plan of care.

4. The identity of the patient's nearest relative.

The correct answer is: The identity of the patient's nearest relative.

The identity of the patient's nearest relative is not a necessary component for securing payment from the insurer during patient documentation. Insurance claims are processed based on clinical information that establishes the medical necessity for services rendered to the patient. While personal details, such as the patient's nearest relative, may be relevant in some contexts—such as emergencies or legal situations—this information does not impact the insurer's assessment of the claim. In contrast, the reason for the encounter and patient history, a patient assessment along with a clinical impression or diagnosis, and a plan of care are all essential components that demonstrate the appropriateness and necessity of the treatment provided. Insurers require this information to evaluate whether the treatment aligns with coverage guidelines and to determine the payment amount for the services rendered. These elements help ensure that the documentation supports the claims made to the insurer, thus facilitating the reimbursement process.