A full denial occurs when the RAC determines that the service billed to CMS was not rendered or was not reasonable or necessary. Which term does this describe?

• A. Full denial
• B. Partial denial
• C. Administrative denial
• D. Non-covered denial

Answer: (A)

When a RAC review finds that the service billed to CMS was not rendered or was not reasonable or necessary, the claim is denied in full. This means the entire submission is rejected for reimbursement, because the service either wasn’t performed or didn’t meet the medical necessity standard for payment. The full denial outcome signals that no portion of the claim is payable under Medicare rules for that service.

It’s helpful to contrast with other denial types: a partial denial would deny only specific line items or CPT codes while others could be paid; an administrative denial covers procedural issues such as missing documentation or timing problems; and a non-covered denial occurs when the service is never payable under Medicare policies, regardless of its medical necessity.