Prior Authorization Quiz

What is the main purpose of Prior Authorization?

• To delay treatment

• To approve insurance coverage for specific procedures

• To replace referrals

• To increase hospital revenue

True or False: A procedure can still be done if prior authorization is denied.

• True

• False

Which of the following typically requires prior authorization?

• Flu shot

• MRI scan

• Routine physical exam

• Over-the-counter medication

Who is responsible for submitting prior authorization requests?

• The patient

• The provider’s office or staff

• The insurance company

• The pharmacy

What happens if prior authorization is not obtained when required?

• Nothing happens

• The claim may be denied

• The patient is fined

• The doctor is fired

Retro‑authorization refers to:

• Requesting approval before the service

• Requesting approval after the service

• Allowing the procedure without approval

• Referring the patient back to provider

Peer Review in this process means:

• A provider-to-provider insurance appeal

• Patient feedback

• Internal audit of claims

• A team meeting

True or False: Prior authorization is only required for inpatient procedures.

• True

• False

If authorization is pending and the appointment is tomorrow, you should:

• Cancel the appointment

• Ignore and hope it’s approved

• Contact provider’s office to initiate the request

• Ask the patient to call insurance

Why might authorization be denied even for approved procedures?

• Lack of supporting medical documentation

• It’s a routine service

• The patient refused

• The provider didn’t refer