WorksheetsHome Health Authorization Quiz
Total questions: 50
Worksheet time: 53mins
What is the primary purpose of home health authorization?
Scheduling visits
Proving medical necessity and coverage
Paying claims
Hiring staff
A signed physician order is required before:
Billing
Authorization submission
Discharge
Staffing
Which insurance type is state-regulated?
Commercial
Medicaid
Employer plans
Self-pay
True or False: Home health services should start before authorization approval.
What document commonly supports medical necessity?
Insurance card
Face-to-face encounter note
Patient ID
Invoice
Medicaid home health benefits are usually:
Unlimited
State-specific
Employer-based
Optional
Commercial insurance rules are best described as:
Identical across payers
Payer-specific
State-mandated
Federal only
What happens if services are provided without authorization?
Automatic approval
Claim denial risk
Higher payment
Faster processing
True or False: Eligibility verification should be done before submitting authorization.
Which of the following is required on most authorization requests?
Provider payroll
CPT/HCPCS codes
Patient signature only
Staff schedule
Medicaid authorizations are often submitted through:
Employer portal
State or MCO portal
Hospital EMR
CMS only
Commercial authorizations may require use of:
Utilization management vendors
State Medicaid office
Social services
Payroll systems
What does “medical necessity” mean?
Service requested by patient
Service required to treat illness or condition
Service preferred by provider
Any home service
True or False: Authorization approval guarantees payment.
What should be tracked after authorization approval?
Staff hours
Visit limits and expiration dates
Payroll dates
Office supplies
Who typically signs home health orders?
Nurse
Physician or authorized provider
Scheduler
Billing staff
A denial means:
Services can continue
Authorization is refused
Claim is paid
Patient is discharged
What is a partial approval?
Denial
Pending request
Reduced visits or duration
Full approval
True or False: All Medicaid patients require homebound status documentation.
What is the first step in the authorization process?
Submit claim
Receive referral/order
Schedule visits
Appeal
Which document is most likely required for continued stay review?
Original referral only
Updated clinical notes
Insurance card
Payroll records
Medicaid Managed Care Organizations (MCOs) often:
Follow federal rules only
Have their own authorization portals
Do not require authorization
Pay automatically
Commercial payers review authorizations mainly for:
Homebound status only
Medical necessity and policy guidelines
Provider availability
Staffing ratios
True or False: Re-authorization timelines vary by payer.
Which factor commonly causes authorization delays?
Early submission
Missing documentation
Correct coding
Clear diagnosis
What information must match across documents?
Provider logo
Dates, diagnosis, and services
Office address
Patient phone number
Medicaid visit limits are usually determined by:
Provider preference
State policy or MCO rules
Patient request
Federal CMS only
What is a face-to-face encounter?
Phone call
In-person or approved telehealth visit with provider
Nurse visit
Home assessment only
True or False: Commercial insurance always requires face-to-face documentation.
What should you do if authorization is close to expiring?
Ignore it
Stop care immediately
Submit re-authorization with updated notes
Bill anyway
Which role commonly submits authorization requests?
HR
Authorization or intake staff
Field clinician
Payroll
What is “units” in authorization?
Staff count
Number of visits or services approved
Dollar amount
Diagnosis code
True or False: Incorrect service codes can result in denial.
Which is an acceptable action after denial?
Continue care without changes
Appeal or resubmit with corrections
Close the chart immediately
Ignore payer response
What should always be documented in the patient record?
Authorization number
Staff vacation
Office meetings
Payroll deductions
A Medicaid denial cites “lack of medical necessity.” What is the best response?
Resubmit same request
Add detailed clinical justification and resubmit/appeal
Discharge patient
Change diagnosis only
Commercial insurers often reduce visits due to:
Staffing shortages
Policy-driven utilization limits
Provider request
Patient age
True or False: Authorization approval dates define the billable service period.
What is the risk of exceeding authorized visits?
Faster payment
Claim denial or recoupment
Automatic extension
Higher reimbursement
What supports medical necessity best for skilled nursing?
Patient preference
Skilled need and measurable goals
Length of stay
Provider availability
Which situation requires immediate re-authorization?
New staffing schedule
Change in patient condition or service frequency
Office relocation
New software
True or False: Medicaid Fee-for-Service and Medicaid MCO rules are always the same.
What is a utilization management vendor?
Billing company
Third party reviewing medical necessity for payers
Staffing agency
State regulator
Which documentation is most critical for therapy services?
Payroll logs
Functional deficits and progress notes
Staff credentials
Office address
When appealing a denial, what should be included?
New insurance card
Clinical rationale and supporting documentation
Staff schedule
Patient complaint
True or False: Authorization rules may differ even within the same insurance company.
What is the best practice to avoid lapses in authorization?
Weekly chart audits and tracking
Waiting for denials
Billing first
Verbal approval only
What does “continued stay” mean?
Initial authorization
Extension of services beyond initial approval
Discharge planning
Staffing coverage
Why is accurate diagnosis coding important?
For scheduling
To support medical necessity and payer review
For payroll
For marketing
True or False: Strong documentation reduces denials for both Medicaid and commercial insurance.
