Free AAMA Certified Medical Assistant (CMA) Practice Question

To prevent payment denial for an elective surgical procedure, a medical assistant must obtain prior authorization or precertification from the patient's insurance company. This guarantees that the procedure is covered under the patient's benefit plan. Failure to obtain this authorization can result in the insurance company refusing to pay for the procedure, potentially leaving the patient with a significant out-of-pocket expense.

Submitting a claim without prior authorization usually leads to automatic claim rejection because the insurance company has not agreed to cover the costs in advance. Notifying the physician's office of the patient's eligibility does not ensure that specific procedures are covered, which is why prior authorization is important, even if the patient is eligible.