WorksheetsHome Health Authorization Quiz
Total questions: 30
Worksheet time: 45mins
What is a home health authorization?
A medical order from the doctor
Approval from the insurance company for home health services
A care plan for the nurse
A billing statement
Why is authorization important before services begin?
It ensures the patient is happy
It guarantees the agency will get paid for services
It allows the nurse to skip paperwork
It’s optional for most patients
Which of the following payers can issue authorizations?
Only Medicare
Only Medicaid
Insurance companies, Medicare, and Medicaid
Only commercial insurance
True or False: Without authorization, an agency may not be reimbursed for home health care.
Another term for authorization is:
Pre-Billing
Prior Authorization or Pre-Certification
Post Approval
Initial Assessment
Name three types of home health services that might require authorization.
The Authorization Specialist acts as a bridge between which three parties?
Doctor, billing department, and patient
Referring provider, payer, and clinical team
Patient, nurse, and scheduler
Insurance agent, doctor, and family
True or False: The Authorization Specialist is responsible for verifying insurance eligibility and benefits.
Which system is used to enter authorizations?
EMR
Excel
Billing software only
Name two key responsibilities of an Authorization Specialist.
Why is it important to keep authorization records organized and compliant?
To help the billing team and prevent denials
To save space
To avoid calling the payer
It’s not required
True or False: Submitting authorizations late has no impact on payment.
What is the first step in the authorization process?
Submit authorization
Review referral packet
Notify care team
Track and follow up
List three things to check in the referral packet.
During eligibility verification, what should you confirm?
If the patient has a phone number
If the policy is active and covers home health services
If the patient has an emergency contact
If the nurse is available
True or False: Eligibility verification helps ensure care is reimbursable.
Which document must be within 90 days before the Start of Care (SOC)?
Insurance card
Face-to-Face (F2F) encounter
Discharge summary
Frequency order
List two submission platforms commonly used for authorizations.
What key details should be included in the authorization request?
Patient/Provider Details
Diagnosis Code/ICD 10
Frequency
Nurse's Schedule
How long is the typical turnaround time for authorization decisions?
1–2 hours
2–5 business days
1–2 weeks
10 business days
What should you do when an authorization is approved?
Record auth number and notify the care team
Wait for the nurse to start care
File it away for later
Ignore until billing requests it
If an authorization is denied, what is the next step?
Ignore the denial
Review reason, appeal, or correct the issue
Start services anyway
Cancel the referral
True or False: It’s important to share authorization results promptly through EMR or email.
When an authorization is pending, what should you do?
Wait without follow-up
Submit missing documentation or monitor for updates
Start care immediately
File for denial
List one example of a situation requiring follow-up (e.g., portal down, expiring authorization).
Which is NOT a common reason for authorization denial?
Missing or expired F2F
Wrong CPT/HCPCS code
Nurse’s signature missing on chart note
Out-of-network provider
True or False: Including recent clinical notes can help prevent “lack of medical necessity” denials.
What should you do if an authorization is about to expire?
Wait until it expires
Track 5 days before expiry and submit an extension
Cancel the patient’s care
Do nothing
Match the authorization type to its definition:
Prior Authorization → Approval obtained ___ services are provided.
Add-On Authorization → Requested when ___ services are needed.
Retro Authorization → Obtained ___ services have been provided.
After, Before, Additional
After, Additional, Before
Before, Additional, After
After, Before, Before
Why is gathering accurate documentation critical for both compliance and patient care access?
