Service Line and Medication Prior Auth Requests

Question 1

Dr. Wang has prescribed physical therapy for his patient, Danielle, following her second knee replacement. Danielle wants to begin therapy immediately as she is anxious to start the recovery process and knows how much the therapy helped her last time. Is it okay to begin therapy before completing a prior authorization?
* No, because all encounters that require a prior authorization should be completed before the first encounter
* Yes, because Danielle only used 8 out of her 10 approved visits from her last surgery so she can use the other 2 while you get approval for a new set of 10 visits
* No, because Danielle is really hard to work with and you know your office may prefer to refer her elsewhere for treatment
* Yes, because you know Danielle’s insurance covered the therapy last time

Answer 1

No, because all encounters that require a prior authorization should be completed before the first encounter

Question 2

Where can prescriptions be found? Select all that apply
* Electronic medical record
* Patient chart
* In an email
* Prescription pad

Answer 2

EMR, Pt Chart, RX pad

Question 3

TRUE/FALSE Initial outpatient verification should be completed before the initial consult, treatment, or test.
* TRUE
* FALSE

Answer 3

True

Question 4

TRUE/FALSE Most prior authorization requests are processed prospectively.
* TRUE
* FALSE

Answer 4

False

Question 5

You have pre-verified the insurance and verification criteria for a patient in your office, Mateo Green. Before submitting the final submission of the prior authorization, who should you speak to?
* fellow office workers to make sure they agree with how you have completed the request
* the ordering physician to let them decide if the prior authorization should be submitted
* the insurance company to let them know you are sending in a prior authorization
* the patient to make sure they agree with how you completed the prior authorization form

Answer 5

he ordering physician to let them decide if the prior authorization should be submitted

Question 6

TRUE/FALSE If an insurance policy terminates during treatment and a new policy begins, the new policy must be worked for verification and authorization.
* TRUE
* FALSE

Answer 6

True

Question 7

TRUE/FALSE As long as the physician has verbally verified medical necessity, it is not necessary to have it written in the medical chart
* FALSE
* TRUE

Answer 7

False

Question 8

What are the steps involved in a prior authorization process? Select all that apply
* ICD-10 and CPT codes assigned
* the service is ordered
* services are performed
* authorization submission
* comparing the patient plan with medical necessity
* making a decision if the patient fits the criteria for medical necessity
* patient is billed
* finding insurance plan medical necessity
* patient is sent an EOB
* verification of insurance

Answer 8

All except: services are performed, pt. is billed, pt is sent EOB

Question 9

What is the final step in the authorization process?
* finding insurance plans medical necessity
* authorization submission
* assigning of the ICD-10 and CPT codes
* insurance verification

Answer 9

Auth submission

Question 10

TRUE/FALSE All medical interventions requiring a prescription require a prior authorization.
* TRUE
* FALSE

Answer 10

False