Office Administrative Assistant Practice Exam

Who is responsible for obtaining a preauthorization for an inpatient hospital procedure?

1. The billing department

2. The provider performing the surgery

3. The medical office assistant

4. The hospital administrator

The correct answer is: The provider performing the surgery

Obtaining a preauthorization for an inpatient hospital procedure is primarily the responsibility of the provider performing the surgery. This is because the provider has the clinical expertise necessary to assess the medical necessity of the procedure and to communicate effectively with the insurance company. They understand the specifics of the patient’s condition and can provide the required documentation that justifies the need for the procedure. While the billing department might handle the financial aspects and the medical office assistant may support the administrative tasks involved in scheduling the procedure, it is the provider who typically initiates the preauthorization process. The hospital administrator is generally not involved in individual patient procedures but rather focuses on overall hospital operations and management. Through this process, the provider ensures that the insurance company agrees to cover the costs associated with the procedure, paving the way for it to be performed proactively without financial complications afterward.