PACS QUESTION BANK 2024/2025 COMPLETE
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The responsibilities of the FDA include: - Answer>>> • Advancing the public health by helping to speed innovations that make medical products more effective, safe, and affordable • Helping the public get the accurate and science-based information they need to use medical products and foods to maintain and improve their health • A is an identifier assigned to a health care provider (such as a physician, optometrist, dentist, or veterinarian) by the United States Drug Enforcement Administration allowing them to write prescriptions for controlled substances. - Answer>>> DEA number • If a patient meets medical criteria - Answer>>> Outlook is good for authorization approval What factors can help to process a prior authorization request successfully? - Answer>>> • Understand how the prior authorization process works • Understand what role each healthcare professional has in the PA process
• Know how to find, evaluate and process the correct information to the patient
• Know how to find and use insurance guidelines
What can be a disadvantage to telephone communication with PA? - Answer>>> • There may be a potential for long hold times • A follow up letter may need to be sent
Supporting information will need to be faxed or sent in another means The provision, coordination, or management of health care and related services among health care providers or by a health care provider with a third party, consultation between health care providers regarding a patient, or the referral of a patient from one health care provider to another is called:
- Answer>>> Treatment
Authorization Companies - Answer>>> Contract with the insurance company
Modality, dose, and fractions are . - Answer>>> part of the radiation therapy order
• Covered entities may include: - Answer>>> • Health plans
• Health care clearinghouses • Any health care provider who transmits health information in electronic form in connection with transactions for which the Secretary of HHS has adopted standards under HIPAA True or False: In the tiering process, a patient will get a non-preferred drug at the lower cost- sharing tier of a preferred drug - Answer>>> True
True or False: Some paper charting systems are still effective, and some hybrid of paper and computer systems can still be found. - Answer>>> True True or False: Once a gap waiver is authorized, the treatment is automatically authorized. - Answer>>> False Medicare is: - Answer>>> a united states government plan for the elderly and disabled
What are some common goals for healthcare professionals when processing a prior authorization request? - Answer>>> Meeting standards for patient safety and therapeutic efficacy
Assigning the correct ICD-10 and CPT codes, and finding the medical necessity policy are: - Answer>>> the steps needed to authorize radiological imaging What is the expected growth of Medicare beneficiaries by the year 2030? - Answer>>> 80 million What staff member in the provider office will most likely spend the most time processing a prior authorization request? - Answer>>> clerical staff If authorization seems unlikely to be approved, the first step is to: - Answer>>> Inform the ordering physician True or False: In comparison to other methods of delivering a medication PA request, an ePA has the slowest determination time. - Answer>>> False.Formats for authorization submission are: - Answer>>> • Payer Portal (Online Authorization)
• ePA
• Fax
• Secure Email
• Phone
CMS devised new rules for Medicare drug plans as of January 1, 2019 for Opioids because: - Answer>>> Overuse of opioid drugs in the United States A retrospective prior authorization is : - Answer>>> when a provider is unaware that a medication needed a Prior authorization until they receive the rejection at the Point of Sale pharmacy
Hormones and Immunoglobulin - Answer>>> are injectables that may require an authorization request Relating to the Medicare Part D program, there are successive levels of appeals for medications. - Answer>>> five (5) What factors can affect a salary range for prior authorization jobs? - Answer>>> Experience, knowledge and education True or False: An infusion lasting 1 hour and 34 minutes is billed for 1 hour. - Answer>>> False.It will be billed for 2 hours.Individuals or entities that commit fraud and abuse in the Medicare and Medicaid Programs may have criminal, civil, and administrative penalties and remedies imposed on them from the government. Violations of these laws may result in: - Answer>>> Criminal and civil liability Why is it important to understand what is in a patient medical record? - Answer>>> To be able to send out the appropriate and necessary supporting documentation for the prior authorization.What is the purpose of a financial contract between the insurer and provider? - Answer>>> To provide a cost reduction of the charges In the authorization process the most important participant is: - Answer>>> Patient
Medicare Advantage is: - Answer>>> A United States government plan for the elderly and disabled through private-sector payers If a provider is already knowledgeable about an insurance plans formulary guidelines, what type of PA is this? - Answer>>> Prospective PA
Prescriptions may be found on: - Answer>>> (1.) a prescription pad
(2.) a patient chart (3.) in the electronic medical record
Why will the use of prior authorizations increase in the future? - Answer>>> Expected rise in Medicare population In-network means: - Answer>>> • The provider has a contract with the insurance company
• Services cost less for the patient
• The provider and patient must research the network
