Payer Types and Coordination of Benefits (COB) Flashcards
6 cards from real CHAA practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 6 Payer Types and Coordination of Benefits (COB) flashcards as text
What is the primary difference between Medicare Part A and Medicare Part B coverage?
Answer: Part A covers inpatient hospital, skilled nursing, hospice, and home health; Part B covers outpatient services, physician visits, and preventive care
Part A focuses on inpatient/facility care and Part B on outpatient/professional services.
A 67-year-old working patient has both Medicare and an employer group health plan. Which is primary?
Answer: The employer plan is primary if the employer has 20 or more employees
Under MSP working-aged rules, the employer plan is primary if the employer has 20+ employees.
What is Medicaid, and how does it differ from Medicare?
Answer: Medicaid is a joint federal-state program for low-income individuals; Medicare is federal for those 65+ or with certain disabilities
Medicaid is needs-based (income) while Medicare is entitlement-based (age/disability).
For a dual-eligible patient (Medicare and Medicaid), what is the COB order?
Answer: Medicare is primary; Medicaid is secondary covering cost-sharing amounts
Medicare is always primary for dual-eligible patients; Medicaid covers deductibles and copayments.
What is TRICARE, and which population does it serve?
Answer: The healthcare program for active duty military, veterans, retirees, and their families
TRICARE is the DoD healthcare system serving military members, retirees, and dependents.
What is subrogation in health insurance, and how does it affect patient access?
Answer: The insurer's right to recover costs from a third party responsible for the patient's injuries, requiring access staff to identify accident-related visits
Subrogation allows insurers to recover costs from responsible third parties.