CHAA - Certified Healthcare Access Associate Insurance Verification and Eligibility 4

Question 1

When a patient has both a primary and secondary insurance plan, what process determines which payer is responsible for reimbursement first?

Accepted Answer

Coordination of Benefits (COB)

Answer

Coordination of Benefits (COB) is the process that determines the order in which multiple insurance plans pay when a patient is covered by more than one plan, preventing duplicate payment and ensuring correct billing sequence.

Question 2

Which of the following best describes a patient's 'effective date' on an insurance policy?

Accepted Answer

The date the insurance coverage begins and services will be covered

Answer

The effective date is the date on which the insurance coverage actually begins. Services rendered before this date are not covered, making it a critical piece of information to verify before providing care.

Question 3

What is the ideal time to perform insurance eligibility verification for a scheduled outpatient procedure?

Accepted Answer

24 to 72 hours before the scheduled appointment

Answer

Verifying eligibility 24 to 72 hours before the appointment allows time to identify coverage issues, obtain any required authorizations, and notify the patient of potential financial responsibility before services are rendered.

Question 4

A patient's insurance plan requires a fixed dollar amount paid at each visit regardless of the total cost of services. This amount is called a:

Accepted Answer

Copayment

Answer

A copayment (copay) is a fixed dollar amount the patient pays for a covered service at the time of the visit. Unlike coinsurance, it does not vary based on the total cost of the service.

Question 5

During eligibility verification, a healthcare access associate discovers the patient's plan requires a referral from a primary care physician before seeing a specialist. This requirement is characteristic of which plan type?

Accepted Answer

Health Maintenance Organization (HMO)

Answer

HMOs typically require patients to select a primary care physician (PCP) who coordinates all care and provides referrals to specialists. Failing to obtain a required referral can result in claim denial.

CHAA - Certified Healthcare Access Associate Practice Test

CHAA - Certified Healthcare Access Associate Practice Test

CHAA - Certified Healthcare Access Associate Insurance Verification and Eligibility 4