PACS Question and Answers Bank
/. _______ processes are layers of testing that must be done before others. - Answer-
✅step
/.What is documented in the patient medical records? - Answer-✅• Laboratory and
other studies are ordered as appropriate
• Working diagnoses that are consistent with findings
• Treatment plans that are consistent with diagnosis
/.True or False: Biologics can be tiered to a lower tier that also contains other biologic
products. - Answer-✅True
/.What staff members are not involved in processing a medication prior authorization
request at an insurance company? Medical review officer, Pharmacist, Pharmacy
technician, Veterinarian? - Answer-✅Veterinarian
/.Information needed to verify insurance eligibility: - Answer-✅NPI number and
insurance policy identification number
/.Medical records may contain copies of: - Answer-✅flouroscopy and MRI
/.Authorizations are required: - Answer-✅• to save money
• to determine proper utilization of medical services
• to protect the patient
/.Medicaid is: - Answer-✅A coordination of health insurance benefits between the
federal government and state government
/.Most gap waivers cover the plan in network provisions of what is called the
______charges. - Answer-✅customary
/.Locations in which patients might receive outpatient infusion: - Answer-✅• physician or
provider's office
• hospitals
• infusion centers
• home infusions
/.Evaluation & Management (E&M) coding - Answer-✅is defined as a process where a
physician-patient encounter or appointment is translated into CPT codes for billing
purposes
, /.Formulary exceptions are: - Answer-✅requests that are for medications on the plan
formulary but do not meet specific criteria
/.When writing an appeal letter, you should include: - Answer-✅• Your identification
• The reason for the denial that they explained in the denial letter
• The correct information
/.ICD-10 codes - Answer-✅Provide an alpha numeric reference for the diagnosis
/.If a gap waiver is approved, ___________________________ - Answer-✅Inform the
patient, physician and scheduler
/.A calendar year policy is from January 1 to December 31 - Answer-✅True
/.What is expected to happen as life expectancy trends upwards? - Answer-✅• higher
medication cost
• higher medication use
/.A PA request can take more than 3 days in order to hear an initial response. - Answer-
✅True
/.Pharmacist, nurse, and medical assistants: - Answer-✅Are some of the healthcare
personnels who play the most important role in the PA process
/.A fast track for authorization is called _______. - Answer-✅urgent
/.Medigap coverage: - Answer-✅• medigap can be bought for any age person who is
enrolled in traditional medicare
• medigap provides for payment of some charges that medicare does not cover
/.True or False: Medigap is only for outpatient services. - Answer-✅False
/.True or False: Medigap is available for Medicare Advantage policies. - Answer-✅False
/.Based on the survey conducted by the American Medical Association in 2019, on
average how long do physicians and staff spend on prior authorization related activities
per week? - Answer-✅16 hours
/. _______ processes are layers of testing that must be done before others. - Answer-
✅step
/.What is documented in the patient medical records? - Answer-✅• Laboratory and
other studies are ordered as appropriate
• Working diagnoses that are consistent with findings
• Treatment plans that are consistent with diagnosis
/.True or False: Biologics can be tiered to a lower tier that also contains other biologic
products. - Answer-✅True
/.What staff members are not involved in processing a medication prior authorization
request at an insurance company? Medical review officer, Pharmacist, Pharmacy
technician, Veterinarian? - Answer-✅Veterinarian
/.Information needed to verify insurance eligibility: - Answer-✅NPI number and
insurance policy identification number
/.Medical records may contain copies of: - Answer-✅flouroscopy and MRI
/.Authorizations are required: - Answer-✅• to save money
• to determine proper utilization of medical services
• to protect the patient
/.Medicaid is: - Answer-✅A coordination of health insurance benefits between the
federal government and state government
/.Most gap waivers cover the plan in network provisions of what is called the
______charges. - Answer-✅customary
/.Locations in which patients might receive outpatient infusion: - Answer-✅• physician or
provider's office
• hospitals
• infusion centers
• home infusions
/.Evaluation & Management (E&M) coding - Answer-✅is defined as a process where a
physician-patient encounter or appointment is translated into CPT codes for billing
purposes
, /.Formulary exceptions are: - Answer-✅requests that are for medications on the plan
formulary but do not meet specific criteria
/.When writing an appeal letter, you should include: - Answer-✅• Your identification
• The reason for the denial that they explained in the denial letter
• The correct information
/.ICD-10 codes - Answer-✅Provide an alpha numeric reference for the diagnosis
/.If a gap waiver is approved, ___________________________ - Answer-✅Inform the
patient, physician and scheduler
/.A calendar year policy is from January 1 to December 31 - Answer-✅True
/.What is expected to happen as life expectancy trends upwards? - Answer-✅• higher
medication cost
• higher medication use
/.A PA request can take more than 3 days in order to hear an initial response. - Answer-
✅True
/.Pharmacist, nurse, and medical assistants: - Answer-✅Are some of the healthcare
personnels who play the most important role in the PA process
/.A fast track for authorization is called _______. - Answer-✅urgent
/.Medigap coverage: - Answer-✅• medigap can be bought for any age person who is
enrolled in traditional medicare
• medigap provides for payment of some charges that medicare does not cover
/.True or False: Medigap is only for outpatient services. - Answer-✅False
/.True or False: Medigap is available for Medicare Advantage policies. - Answer-✅False
/.Based on the survey conducted by the American Medical Association in 2019, on
average how long do physicians and staff spend on prior authorization related activities
per week? - Answer-✅16 hours
