CPAT Prior Authorization & Precertification

Question 1

Which term describes the process of obtaining approval from a payer before a non-emergency medical service is rendered?

Accepted Answer

Prior authorization

Answer

Prior authorization requires advance payer approval before certain services are performed to confirm medical necessity and coverage.

Question 2

A patient needs an elective MRI. The hospital submits clinical documentation to the insurer before the procedure. This process is called:

Accepted Answer

Precertification

Answer

Precertification is the pre-service step where the provider notifies the payer and obtains approval before a scheduled procedure.

Question 3

Which of the following services most commonly requires prior authorization?

Accepted Answer

Elective inpatient surgery

Answer

Elective inpatient surgeries typically require prior authorization because of their high cost and the need to confirm medical necessity.

Question 4

What information is typically NOT required when submitting a prior authorization request?

Accepted Answer

Patient's social media profile

Answer

Prior authorization requests require clinical and billing information such as diagnosis codes, procedure codes, and provider identifiers—not personal social media data.

Question 5

When a payer denies a prior authorization request, the most appropriate initial step for the patient account technician is to:

Accepted Answer

Initiate a peer-to-peer review request

Answer

A peer-to-peer review allows the treating physician to speak directly with the payer's medical reviewer to appeal a denial based on clinical justification.

CPAT - Certified Patient Account Technician Practice Test

CPAT - Certified Patient Account Technician Practice Test

CPAT Prior Authorization & Precertification