Cuestionario vinculado a una guía · Medio Nivel

IA en el cuestionario de autorización previa

Pruebe lo que sabe sobre cómo la IA acelera la autorización previa, los estándares Da Vinci basados en FHIR y la regulación de las denegaciones de seguros automatizadas.

Rutas de guía relacionadasIA en autorización previa
Pregunta 1 de 8

What is prior authorization?

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Las respuestas y explicaciones aparecen a medida que realiza el cuestionario.

  1. What is prior authorization?
    • A patient's consent form for surgery
    • A process in which a health plan must approve certain services before it pays for them
    • A hospital's internal scheduling system
    • A government license for doctors
  2. What does the HL7 Da Vinci project provide?
    • A proprietary insurer denial algorithm
    • A federal law on insurance coverage
    • A medical imaging standard
    • FHIR-based workflows for checking coverage requirements, collecting documentation and submitting requests
  3. The class action involving naviHealth's nH Predict tool concerned what type of care?
    • Post-acute care in Medicare Advantage
    • Emergency surgery
    • Prescription eyeglasses
    • Dental cleanings
  4. What does it mean that payer-side automation is often 'asymmetric by design'?
    • It denies all requests by default
    • It only works for large hospitals
    • It auto-approves clear requests while routing uncertain or adverse cases to clinicians
    • It processes requests in random order
  5. What did CMS tell Medicare Advantage plans about algorithms?
    • Algorithms must make all coverage decisions
    • Algorithms cannot be the sole basis for denying care without considering the individual patient
    • Algorithms are banned entirely
    • Algorithms may only be used for dental care
  6. The Prior Authorization Support guide maps FHIR requests to which transaction required under HIPAA?
    • DICOM
    • HL7 v2 ADT
    • ICD-10
    • X12 278
  7. What is gold-carding?
    • Exempting clinicians with high approval rates from some prior authorization reviews
    • A premium insurance plan for wealthy patients
    • A credit card used to pay copays
    • A penalty for clinicians with many denials
  8. According to the guide, what failure mode have regulators targeted?
    • Using FHIR instead of fax
    • Publishing prior authorization metrics
    • Treating a predicted length of stay as if it were a coverage determination
    • Auto-approving requests that meet criteria