CHAA Pre-Authorization and Referrals Management 3

Question 1

What happens to financial responsibility if pre-authorization is not obtained before an elective service?

Accepted Answer

The patient may be responsible for the entire cost if insurance denies the claim

Answer

Insurance always pays regardless

Answer

The hospital absorbs the cost

Answer

No impact on financial responsibility

Question 2

How should patient access manage authorizations for recurring treatments like physical therapy?

Accepted Answer

Track authorized visits, monitor approaching limits, and proactively request re-authorization before visits are exhausted

Answer

One authorization covers all future visits

Answer

Patient tracks their own authorizations

Answer

Recurring treatments never need authorization

Question 3

What is a 'gold card' or prior authorization exemption program?

Accepted Answer

It exempts providers with high approval rates from certain authorization requirements, reducing administrative burden

Answer

A patient loyalty program

Answer

A premium insurance card

Answer

Eliminates all insurance requirements

Question 4

When multiple services are scheduled for the same day, how should authorizations be managed?

Accepted Answer

Each service may need its own authorization, verified and obtained independently

Answer

One authorization covers all same-day services

Answer

Same-day services never need authorization

Answer

The referring physician handles all authorizations

Question 5

What role does the utilization review nurse play in pre-authorization, and how does patient access collaborate?

Accepted Answer

UR provides clinical documentation and medical necessity justification that patient access coordinates into the submission and tracking process

Answer

UR replaces patient access involvement

Answer

UR only works on inpatient cases

Answer

They work independently

Question 6

A patient needs an urgent MRI but the payer's authorization line is closed after hours. What should patient access do?

Accepted Answer

Document the urgency, proceed under the urgent authorization protocol, and submit the request next business day

Answer

Refuse to schedule until authorization is obtained

Answer

Tell the patient to go elsewhere

Answer

Bill as self-pay