Patient Financial Services & Collections Flashcards
6 cards from real AAPC practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 6 Patient Financial Services & Collections flashcards as text
What does 'self-pay' mean in healthcare billing?
Answer: A patient who pays for all or part of their medical expenses out of pocket without insurance
Self-pay patients are uninsured or underinsured individuals who are responsible for paying their healthcare costs directly.
What is a credit balance on a patient account?
Answer: An amount owed back to the patient or payer because they were overcharged or overpaid
A credit balance occurs when payments and adjustments exceed the charges, requiring a refund to the patient or payer.
What is the primary purpose of the No Surprises Act (2022)?
Answer: To protect patients from unexpected medical bills, especially from out-of-network providers
The No Surprises Act limits out-of-network charges for emergency services and certain non-emergency services, protecting patients from balance billing.
An Advance Beneficiary Notice (ABN) is issued to Medicare patients when:
Answer: The provider believes Medicare may deny the claim and the patient may be responsible for the cost
An ABN informs Medicare beneficiaries in advance that a service may not be covered by Medicare and that they will be financially responsible if denied.
What is balance billing?
Answer: Billing the patient for the difference between the provider's charge and the payer's allowed amount
Balance billing occurs when a provider bills a patient for the difference between their charge and the amount the insurer allows, which is often prohibited for in-network providers.
What is a good faith estimate under the No Surprises Act?
Answer: A written estimate of expected costs provided to uninsured or self-pay patients before scheduled services
The No Surprises Act requires providers to give uninsured patients a good faith estimate of expected charges before scheduled items or services.