PACS Technology & Information Systems in Prior Authorization

Question 1

Which ASC X12 transaction set is the HIPAA-mandated standard for submitting prior authorization requests and referrals?

Accepted Answer

ASC X12 278

Answer

ASC X12 837

Answer

ASC X12 270

Answer

ASC X12 835

Question 2

What is the primary purpose of an Electronic Prior Authorization (ePA) system?

Accepted Answer

To automate and streamline the PA submission and approval workflow

Answer

To store patient demographic information for billing

Answer

To process medical claims after services are rendered

Answer

To manage provider credentialing and network enrollment

Question 3

Which organization develops and maintains the NCPDP SCRIPT standard used for electronic pharmacy prior authorization?

Accepted Answer

National Council for Prescription Drug Programs (NCPDP)

Answer

American Medical Association (AMA)

Answer

Centers for Medicare & Medicaid Services (CMS)

Answer

Health Level Seven International (HL7)

Question 4

What does 'real-time prior authorization' mean in the context of electronic PA systems?

Accepted Answer

Immediate automated approval or denial decisions generated at the point of care

Answer

PA requests processed and resolved within 24 hours

Answer

PA decisions delivered during a live phone call with the payer's clinical team

Answer

Electronic submission of PA requests via a secure fax portal

Question 5

Under the 21st Century Cures Act, CMS was directed to implement electronic prior authorization for which Medicare program?

Accepted Answer

Medicare Part D (prescription drug plans)

Answer

Medicare Part A (hospital insurance)

Answer

Medicare Part B (medical insurance)

Answer

Medicare Advantage only

Question 6

What is the key benefit of integrating prior authorization systems with Electronic Health Records (EHR)?

Accepted Answer

It enables automatic population of clinical data into PA requests, reducing manual data entry

Answer

It eliminates the need for prior authorization entirely

Answer

It transfers financial liability from payers to providers for denied claims

Answer

It replaces the need for clinical criteria in PA decision-making

Question 7

Which federal rule, finalized in 2024, requires impacted payers to implement HL7 FHIR-based APIs to streamline prior authorization processes?

Accepted Answer

CMS Interoperability and Prior Authorization Final Rule (CMS-0057-F)

Answer

HIPAA Omnibus Final Rule

Answer

Affordable Care Act Section 1557 Nondiscrimination Rule

Answer

No Surprises Act Transparency Rule