PACS Cheat Sheet 2026

The 30 highest-yield PACS facts, distilled from real exam questions. Print it, save it as a PDF, or study it here — free, no sign-up.

1. Under the CMS Interoperability and Prior Authorization Final Rule, what is a key continuous improvement obligation for impacted payers? → Payers must publish PA metrics annually and implement APIs to streamline PA requests
2. When documenting a communication with a provider about a PA decision, which element is LEAST necessary in the case notes? → The provider's personal opinion of the plan's medical director
3. What does the prefix 'hyper-' mean in medical terminology? → Above normal or excessive
4. What does the suffix '-ectomy' mean? → Removal
5. For a prior authorization tracking system to support internal audits effectively, it must include which of the following fields? → Authorization status history with timestamps for each status change
6. Under CMS Medicare Advantage regulations, what is the maximum timeframe for a standard prior authorization decision? → 3 business days
7. A payer requests additional clinical documentation during the prior authorization review process. This request is commonly called a(n): → Additional Development Request (ADR)
8. Proton pump inhibitors (PPIs) such as omeprazole are prescribed primarily to treat: → Gastroesophageal reflux disease (GERD) and peptic ulcers
9. When a prior authorization is denied, which regulatory timeframe must Medicare Advantage plans meet for providing a written denial notice? → 72 hours for standard decisions
10. A health plan updates its PA clinical criteria for a drug class mid-year. What is the FIRST step a PA specialist should take upon learning of this update? → Alert the compliance team and update internal reference tools to reflect new criteria
11. A hospital submits a prior authorization request for an inpatient admission. The health plan must issue an urgent (expedited) decision when: → Applying the standard timeline could seriously jeopardize the member's health
12. Which suffix indicates surgical removal of an organ or structure? → -ectomy
13. When a PACS specialist identifies a pattern of inappropriate authorizations tied to a specific diagnosis code, what risk management action is most appropriate? → Conduct a focused retrospective audit and escalate findings to the medical director
14. What does the prefix 'cardio-' refer to? → Heart
15. Which tool helps verify insurance eligibility electronically? → Eligibility verification portals
16. What clinical information is most critical when documenting step therapy requirements in a prior authorization request? → Evidence of trial and failure of required first-line therapies
17. Under the ACA's internal appeals and external review provisions, what happens if a health plan fails to strictly adhere to claims and appeals procedures? → The member's claim is automatically granted
18. What does 'real-time prior authorization' mean in the context of electronic PA systems? → Immediate automated approval or denial decisions generated at the point of care
19. Under the 2024 CMS Interoperability and Prior Authorization Final Rule, health plans must implement FHIR APIs for PA to promote: → Electronic submission and status tracking of PA requests to reduce administrative burden
20. Under the No Surprises Act's prior authorization transparency provisions, health plans must publicly report PA data including: → Percentage of PA requests approved, denied, and overturned on appeal by service category
21. A provider office submits a PA with incomplete clinical information. What is the PACS specialist's MOST appropriate action? → Contact the provider to request the specific missing documentation
22. Under the CMS-0057-F Prior Authorization Final Rule, what new requirement applies to the content of PA denial notices for impacted payers? → Denials must include the specific reason for denial and a list of alternative treatments
23. Which standard-setting organization publishes the InterQual criteria commonly used by health plans for prior authorization clinical reviews? → Change Healthcare (MCG Health)
24. The National Committee for Quality Assurance (NCQA) requires that physician reviewers who make adverse determinations in prior authorization be licensed in: → The same state where the member resides or receives care
25. A PACS specialist notices that a specific provider consistently submits incomplete PA requests. The MOST effective long-term solution is: → Offer provider education on submission requirements and documentation standards
26. When a concurrent authorization review is conducted for an inpatient stay, clinical updates must be submitted: → At defined intervals throughout the stay to justify continued medical necessity
27. Under the ACA, which category of services must most health plans cover without patient cost-sharing (no copay, deductible, or coinsurance)? → Preventive services rated A or B by the U.S. Preventive Services Task Force (USPSTF)
28. When a prior authorization is obtained for a procedure that later changes in scope, the PACS specialist should: → Document the change and submit a new or amended authorization request
29. Which metrics are most important for a comprehensive monitoring strategy? → Availability, performance, error rates, and resource utilization
30. Which federal regulation most directly governs the risk that a Medicare Advantage plan faces when denying prior authorization requests? → 42 CFR Part 422