PACS Documentation & Record Management 2 — Questions and Answers
Question 1: When a prior authorization request is denied, which document must be retained to support a potential appeal?
- The original prescription pad
- The denial notice with the stated clinical rationale (Correct answer)
- The patient's insurance card copy
- The provider's NPI registration certificate
Correct answer: The denial notice with the stated clinical rationale
The denial notice containing the insurer's clinical rationale is the foundational document needed to construct a medical necessity appeal.
Question 2: Under HIPAA, a covered entity must provide a patient access to their medical records within how many days of a request?
- 10 days
- 30 days (Correct answer)
- 60 days
- 90 days
Correct answer: 30 days
HIPAA's Privacy Rule requires covered entities to act on a records-access request within 30 days, with one possible 30-day extension.
Question 3: A PACS specialist discovers that a prior authorization file is missing the treating physician's signature on the clinical attestation. What is the correct next step?
- Submit the file immediately to avoid delay
- Mark the file complete and archive it
- Contact the provider's office to obtain the missing signature before submission (Correct answer)
- Replace the signature field with the specialist's initials
Correct answer: Contact the provider's office to obtain the missing signature before submission
An unsigned clinical attestation is an incomplete document; the provider must sign before submission to prevent a technical denial.
Question 4: Which retention period is commonly required for adult patient medical records under most US state laws?
- 2 years
- 5 years
- 7 years (Correct answer)
- 15 years
Correct answer: 7 years
Most states mandate a minimum 7-year retention period for adult medical records, though some states and payers require longer.
Question 5: An authorization was granted six months ago but the patient never received the service. How should this record be documented?
- Deleted, since the service was not rendered
- Marked as expired and retained per policy (Correct answer)
- Converted to a new active authorization
- Filed under denied authorizations
Correct answer: Marked as expired and retained per policy
Expired authorizations must be retained with an 'expired/unused' notation to maintain an accurate audit trail.
Question 6: Which element is required in an authorization tracking log to meet payer audit requirements?
- Patient's Social Security Number in plain text
- Date the authorization was requested and the date a decision was received (Correct answer)
- Provider's home address
- Patient's credit card information
Correct answer: Date the authorization was requested and the date a decision was received
Payer audits verify timeliness compliance, so the request date and decision date must be logged for every authorization.
Question 7: When submitting clinical documentation to support a prior authorization, what is the purpose of including peer-reviewed clinical guidelines?
- To replace the treating physician's notes entirely
- To demonstrate that the requested service aligns with evidence-based medical necessity criteria (Correct answer)
- To satisfy state insurance licensing requirements
- To extend the authorization validity period automatically
Correct answer: To demonstrate that the requested service aligns with evidence-based medical necessity criteria
Payers evaluate requests against evidence-based criteria, so citing recognized guidelines strengthens the medical necessity argument.
PACS Documentation & Record Management 2
When a prior authorization request is denied, which document must be retained to support a potential appeal?