AAPC Patient Financial Services & Collections 2 — Questions and Answers
Question 1: What does the Fair Debt Collection Practices Act (FDCPA) regulate?
- How providers submit claims to Medicare
- The conduct of debt collectors when collecting consumer debts, including medical bills (Correct answer)
- Medicare reimbursement rates
- HIPAA privacy requirements
Correct answer: The conduct of debt collectors when collecting consumer debts, including medical bills
The FDCPA prohibits abusive, deceptive, and unfair debt collection practices and gives consumers rights when dealing with third-party collectors.
Question 2: When a practice turns over a patient balance to a collection agency, what typically happens?
- The patient's balance is forgiven
- The agency attempts to collect the debt, often for a percentage of the amount recovered (Correct answer)
- The provider receives full payment immediately
- The insurance company pays the balance
Correct answer: The agency attempts to collect the debt, often for a percentage of the amount recovered
Collection agencies work on a contingency basis, keeping a percentage of the amount they recover from patients on behalf of the provider.
Question 3: What is a 'small balance write-off' policy?
- Writing off all unpaid claims
- Writing off patient or payer balances below a specified threshold amount rather than pursuing collection (Correct answer)
- A Medicare penalty reduction
- An insurance adjustment
Correct answer: Writing off patient or payer balances below a specified threshold amount rather than pursuing collection
Small balance write-off policies save administrative costs by not pursuing amounts whose collection cost exceeds the balance owed.
Question 4: What is a health insurance deductible?
- The monthly insurance premium
- The amount a patient must pay out-of-pocket before insurance begins covering costs (Correct answer)
- A fixed co-pay per visit
- The maximum out-of-pocket limit
Correct answer: The amount a patient must pay out-of-pocket before insurance begins covering costs
A deductible is the annual amount a patient pays for covered healthcare services before the insurance plan starts to pay its share.
Question 5: In patient billing, who is the 'guarantor'?
- The treating physician
- The person legally responsible for paying the patient's bill (Correct answer)
- The insurance company
- The billing specialist
Correct answer: The person legally responsible for paying the patient's bill
The guarantor is the individual responsible for the account balance, which may be the patient, a parent, or a legal guardian.
Question 6: What is the purpose of a patient statement?
- To submit claims to payers
- To inform the patient of their balance due after insurance has been applied (Correct answer)
- To verify insurance eligibility
- To document clinical findings
Correct answer: To inform the patient of their balance due after insurance has been applied
A patient statement details the services rendered, insurance payments received, adjustments made, and the remaining balance the patient owes.
AAPC Patient Financial Services & Collections 2
What does the Fair Debt Collection Practices Act (FDCPA) regulate?