1 for specific request mail
Prior Authorization Certification Specialist (PACS)
Question Bank Questions and Correct Answers |
Latest Update
When did insurance companies start using the current prior
authorization system?
Before 1920
Between 1920 and 1930
Between 1930 and 1940
Assignment Expert
After 1950 Ans: After 1950
Guru01 - Stuvia
Which of the following organizations recently issued a statement
opposing copay accumulator and maximizer programs?
ASHP
2026
ASCO
©
AMA
APhA Ans: ASCO
What is HIPAA?
-Standards for individuals' privacy rights to understand and control how
their health information is used
-United States legislation that provides data privacy and security
provisions for safeguarding medical information
-Entities that process nonstandard health information they receive from
another entity and convert them to a standard
, 2 for specific request mail
-The use and disclosure of individuals' health information Ans: United
States legislation that provides data privacy and security provisions for
safeguarding medical information
A patient receives an infusion that contains the following three
medications and doses:
Benadryl 25 mg IVP x 1
Solu-medrol 1 g IV over 41 minutes
Remicade 400 mg IV over 2 hours, 37 minutes
Assignment Expert
How many billing codes would you use for the Remicade and why?
Guru01 - Stuvia
-1 code: bill for 3 hours using the same code.
-3 codes: one code is used to bill for the initial hour, a second code is
used to bill for the second full hour, and a third code is used to bill for
the partial hour (37 minutes)
2026
-2 codes: one code is used to bill for the drug used and the other is used
©
to bill for the time
2 codes: one code is used to bill for the initial hour and the other code is
used to bill for 2 additional hours Ans: 2 codes: one code is used to bill
for the initial hour and the other code is used to bill for 2 additional
hours
Dr. Valejos sent her patient Merrida M. to see the cardiologist, Dr.
Jackson, for an irregular heart beat last month. When reviewing the
Electronic Health Record (EHR) what documentation do you need to see in
order to verify Dr. Valejos reviewed the report.
-Since the report is only entered into the chart after the physician's
review no other documentation is needed.
-Dr. Valejos's electronic signature
, 3 for specific request mail
-A note from Dr. Valejos' nurse that verify the record has been reviewed
-Dr. Valejos' hand-written signature or initials Ans: Dr. Valejos's
electronic signature
TRUE/FALSE Insurance plans are variable regarding the information
needed for prior authorization, but there are some consistencies for
certain diagnoses and disease states. Ans: True
TRUE/FALSE ICD-10 codes represent diagnosis, while CPT codes represent
procedural codes Ans: True
Assignment Expert
What is the minimum and the maximum number of characters an ICD-10
code can have?
Guru01 - Stuvia
3, 9
3, 7
5, 9
2026
1, 7 Ans: 3, 7
©
A radiation oncologist writes an order that reads: IMRT of the ovary, 30
fractions, 5400 cGy. Which part of the order is missing?
-Side of body (left or right) of ovary
-Number of treatments
-Amount of radiation
-Modality or type of therapy Ans: Side of body (left or right) of ovary
Which outpatient service helps people with a physical, sensory, or
cognitive disability become as independent as possible in all areas of
their lives.?
-Physical therapy
, 4 for specific request mail
-Infusion therapy
-Speech therapy
-Occupational therapy Ans: Occupational therapy
A patient needs 2.5 liters/day of IV fluids. Under which condition would
this be billed?
-When the IV fluids are administered with a billed IVP drug.
-When the IV fluids are used to dilute another billed medication
Assignment Expert
-When the IV fluids are administered to maintain the IV line.
-When the IV fluids are the only product being administered. Ans: When
Guru01 - Stuvia
the IV fluids are the only product being administered.
Which healthcare provider is responsible for loading the authorization
approvals into the payer software systems?
2026
-Pharmacy Technician (Intake side)
©
-Retail Pharmacist
-Retail Pharmacy Technician
-Specialty Pharmacist Ans: Pharmacy Technician (Intake side)
The treatment plan section of the medical record needs to be
______________ to provide a solid case for insurance approval?
-Be written in a step-by-step format
-Clearly communicated to the patient
-Contain the physician's signature for proof of review
-Consistent with the diagnosis Ans: Consistent with the diagnosis
Which item or service may require service line prior authorization?
Prior Authorization Certification Specialist (PACS)
Question Bank Questions and Correct Answers |
Latest Update
When did insurance companies start using the current prior
authorization system?
Before 1920
Between 1920 and 1930
Between 1930 and 1940
Assignment Expert
After 1950 Ans: After 1950
Guru01 - Stuvia
Which of the following organizations recently issued a statement
opposing copay accumulator and maximizer programs?
ASHP
2026
ASCO
©
AMA
APhA Ans: ASCO
What is HIPAA?
-Standards for individuals' privacy rights to understand and control how
their health information is used
-United States legislation that provides data privacy and security
provisions for safeguarding medical information
-Entities that process nonstandard health information they receive from
another entity and convert them to a standard
, 2 for specific request mail
-The use and disclosure of individuals' health information Ans: United
States legislation that provides data privacy and security provisions for
safeguarding medical information
A patient receives an infusion that contains the following three
medications and doses:
Benadryl 25 mg IVP x 1
Solu-medrol 1 g IV over 41 minutes
Remicade 400 mg IV over 2 hours, 37 minutes
Assignment Expert
How many billing codes would you use for the Remicade and why?
Guru01 - Stuvia
-1 code: bill for 3 hours using the same code.
-3 codes: one code is used to bill for the initial hour, a second code is
used to bill for the second full hour, and a third code is used to bill for
the partial hour (37 minutes)
2026
-2 codes: one code is used to bill for the drug used and the other is used
©
to bill for the time
2 codes: one code is used to bill for the initial hour and the other code is
used to bill for 2 additional hours Ans: 2 codes: one code is used to bill
for the initial hour and the other code is used to bill for 2 additional
hours
Dr. Valejos sent her patient Merrida M. to see the cardiologist, Dr.
Jackson, for an irregular heart beat last month. When reviewing the
Electronic Health Record (EHR) what documentation do you need to see in
order to verify Dr. Valejos reviewed the report.
-Since the report is only entered into the chart after the physician's
review no other documentation is needed.
-Dr. Valejos's electronic signature
, 3 for specific request mail
-A note from Dr. Valejos' nurse that verify the record has been reviewed
-Dr. Valejos' hand-written signature or initials Ans: Dr. Valejos's
electronic signature
TRUE/FALSE Insurance plans are variable regarding the information
needed for prior authorization, but there are some consistencies for
certain diagnoses and disease states. Ans: True
TRUE/FALSE ICD-10 codes represent diagnosis, while CPT codes represent
procedural codes Ans: True
Assignment Expert
What is the minimum and the maximum number of characters an ICD-10
code can have?
Guru01 - Stuvia
3, 9
3, 7
5, 9
2026
1, 7 Ans: 3, 7
©
A radiation oncologist writes an order that reads: IMRT of the ovary, 30
fractions, 5400 cGy. Which part of the order is missing?
-Side of body (left or right) of ovary
-Number of treatments
-Amount of radiation
-Modality or type of therapy Ans: Side of body (left or right) of ovary
Which outpatient service helps people with a physical, sensory, or
cognitive disability become as independent as possible in all areas of
their lives.?
-Physical therapy
, 4 for specific request mail
-Infusion therapy
-Speech therapy
-Occupational therapy Ans: Occupational therapy
A patient needs 2.5 liters/day of IV fluids. Under which condition would
this be billed?
-When the IV fluids are administered with a billed IVP drug.
-When the IV fluids are used to dilute another billed medication
Assignment Expert
-When the IV fluids are administered to maintain the IV line.
-When the IV fluids are the only product being administered. Ans: When
Guru01 - Stuvia
the IV fluids are the only product being administered.
Which healthcare provider is responsible for loading the authorization
approvals into the payer software systems?
2026
-Pharmacy Technician (Intake side)
©
-Retail Pharmacist
-Retail Pharmacy Technician
-Specialty Pharmacist Ans: Pharmacy Technician (Intake side)
The treatment plan section of the medical record needs to be
______________ to provide a solid case for insurance approval?
-Be written in a step-by-step format
-Clearly communicated to the patient
-Contain the physician's signature for proof of review
-Consistent with the diagnosis Ans: Consistent with the diagnosis
Which item or service may require service line prior authorization?
