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WorksheetsPrior Authorization Quiz
Total questions: 10
Worksheet time: 3mins
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
