Quiz — Admissions, Eligibility, and Medical Necessity

1. Which statement best documents functional impairment?

Participant is unmotivated and isolative.

Participant has severe symptoms affecting all areas.

Participant leaves home once weekly; missed 4 of 6 scheduled appointments in 60 days due to difficulty planning transportation.

Participant needs PRP services.

2. A referral arrives without documentation of functional impairment. You should:

Admit and gather it during the first 30 days

Obtain the documentation before admission

Write an impairment statement from your impression

Deny the referral without follow-up

3. Medical necessity connects diagnosis, functional impairment, the proposed service, and:

Available staffing

The risk if the service is not provided

The participant's insurance tier

Program census targets

Quiz: Admissions, Eligibility, and Medical Necessity